Characteristics of a COVID-19 cohort with large vessel occlusion: A multicenter international study
Authors
Pascal Jabbour, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Adam A. Dmytriw, Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA.
Ahmad Sweid, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Michel Piotin, Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
Kimon Bekelis, Department of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA.Follow
Nader Sourour, Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
Eytan Raz, Department of Radiology, New York University Langone Medical Center, New York, New York, USA.
Italo Linfante, Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA.
Guilherme Dabus, Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA.Follow
Max Kole, Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
Mario Martínez-Galdámez, Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
Shahid M. Nimjee, Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Demetrius K. Lopes, Advocate Aurora HealthFollow
Ameer E. Hassan, Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA.
Peter Kan, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Mohammad Ghorbani, Department of Neurosurgery, Firoozgar Hospital, Tehran, Iran.
Michael R. Levitt, Departments of Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA.
Simon Escalard, Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
Symeon Missios, Department of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA.
Maksim Shapiro, Department of Radiology, New York University Langone Medical Center, New York, New York, USA.
Frédéric Clarençon, Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.Follow
Mahmoud Elhorany, Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
Daniel Vela-Duarte, Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA.
Rizwan A. Tahir, Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
Patrick P. Youssef, Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Aditya S. Pandey, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Robert M. Starke, Department of Neurosurgery & Neuroradiology, University of Miami & Jackson Memorial Hospital, Miami, Florida, USA.
Kareem El Naamani, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Rawad Abbas, Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Bassel Hammoud, Department of Biomedical Engineering, American University of Beirut, Beirut, Lebanon.
et al
Recommended Citation
Jabbour P, Dmytriw AA, Sweid A, et al. Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study. Neurosurgery. 2022;90(6):725-733. doi:10.1227/neu.0000000000001902
Abstract
Background: The mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke.
Objective: To describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort.
Methods: We conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020.
Results: The total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002).
Conclusion: COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.
