International controlled study of revascularization and outcomes following COVID-positive mechanical thrombectomy.

Abstract

BACKGROUND AND PURPOSE:

Previous studies suggest that mechanisms and outcomes in patients with COVID-19-associated stroke differ from those in patients with non-COVID-19-associated strokes, but there is limited comparative evidence focusing on these populations. The aim of this study, therefore, was to determine if a significant association exists between COVID-19 status with revascularization and functional outcomes following thrombectomy for large vessel occlusion (LVO), after adjustment for potential confounding factors.

METHODS:

A cross-sectional, international multicenter retrospective study was conducted in consecutively admitted COVID-19 patients with concomitant acute LVO, compared to a control group without COVID-19. Data collected included age, gender, comorbidities, clinical characteristics, details of the involved vessels, procedural technique, and various outcomes. A multivariable-adjusted analysis was conducted.

RESULTS:

In this cohort of 697 patients with acute LVO, 302 had COVID-19 while 395 patients did not. There was a significant difference (p < 0.001) in the mean age (in years) and gender of patients, with younger patients and more males in the COVID-19 group. In terms of favorable revascularization (modified Thrombolysis in Cerebral Infarction [mTICI] grade 3), COVID-19 was associated with lower odds of complete revascularization (odds ratio 0.33, 95% confidence interval [CI] 0.23-0.48; p < 0.001), which persisted on multivariable modeling with adjustment for other predictors (adjusted odds ratio 0.30, 95% CI 0.12-0.77; p = 0.012). Moreover, endovascular complications, in-hospital mortality, and length of hospital stay were significantly higher among COVID-19 patients (p < 0.001).

CONCLUSION:

COVID-19 was an independent predictor of incomplete revascularization and poor functional outcome in patients with stroke due to LVO. Furthermore, COVID-19 patients with LVO were more often younger and had higher morbidity/mortality rates.

• Authors: Adam A Dmytriw, Sherief Ghozy, Ahmad Sweid, Michel Piotin, Kimon Bekelis, Nader Sourour, Eytan Raz, Daniel Vela-Duarte, Italo Linfante, Guilherme Dabus, Max Kole, Mario Martínez-Galdámez, Shahid M Nimjee, Demetrius K Lopes, Ameer E Hassan, Peter Kan, Mohammad Ghorbani, Michael R Levitt, Simon Escalard, Symeon Missios, Maksim Shapiro, Fréderic Clarençon, Mahmoud Elhorany, Rizwan A Tahir, Patrick P Youssef, Aditya S Pandey, Robert M Starke, Kareem El Naamani, Rawad Abbas, Ossama Y Mansour, Jorge Galvan, Joshua T Billingsley, Abolghasem Mortazavi, Melanie Walker, Mahmoud Dibas, Fabio Settecase, Manraj K S Heran, Anna L Kuhn, Ajit S Puri, Bijoy K Menon, Sanjeev Sivakumar, Ashkan Mowla, Salvatore D'Amato, Alicia M Zha, Daniel Cooke, Justin E Vranic, Robert W Regenhardt, James D Rabinov, Christopher J Stapleton, Mayank Goyal, Hannah Wu, Jake Cohen, David Turkel-Parella, Andrew Xavier, Muhammad Waqas, Vincent Tutino, Adnan Siddiqui, Gaurav Gupta, Anil Nanda, Priyank Khandelwal, Cristina Tiu, Pere C Portela, Natalia Perez de la Ossa, Xabier Urra, Mercedes de Lera, Juan F Arenillas, Marc Ribo, Manuel Requena, Mariangela Piano, Guglielmo Pero, Keith De Sousa, Fawaz Al-Mufti, Zafar Hashim, Sanjeev Nayak, Leonardo Renieri, Rose Du, Mohamed A Aziz-Sultan, David Liebeskind, Raul G Nogueira, Mohamad Abdalkader, Thanh N Nguyen, Nicholas Vigilante, James E Siegler, Jonathan A Grossberg, Hassan Saad, Michael R Gooch, Nabeel A Herial, Robert H Rosenwasser, Stavropoula Tjoumakaris, Aman B Patel, Ambooj Tiwari, Pascal Jabbour, North American Neurovascular COVID-19 (NAN-C) Consortium & Society of Vascular and Interventional Neurology (SVIN) Investigators
• Journal: European journal of neurology (Eur J Neurol) Vol. 29 Issue 11 Pg. 3273-3287 (11 2022) ISSN: 1468-1331 [Electronic] England
• PMID: 35818781 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2022 European Academy of Neurology.

Topics

• Brain Ischemia
• COVID-19 (complications)
• Cross-Sectional Studies
• Endovascular Procedures (methods)
• Humans
• Male
• Retrospective Studies
• Stroke (surgery)
• Thrombectomy (methods)
• Treatment Outcome