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

Authors

• Adam A. Dmytriw, Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, MA, USA.
• Sherief Ghozy, Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 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.
• Daniel Vela-Duarte, Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Florida, USA.
• Italo Linfante, Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Florida, USA.
• Guilherme Dabus, Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Florida, USA.Follow
• Max Kole, Department of Neurosurgery, Henry Ford Hospital, Michigan, USA.
• Mario Martínez-Galdámez, Department of Interventional Neuroradiology, Hospital Clinico Universitario de 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, UTMB, Houston, Texas, USA.
• Mohammad Ghorbani, Department of Neurosurgery, Firoozgar Hospital, 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.
• Fréderic Clarençon, Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.Follow
• Mahmoud Elhorany, Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
• Rizwan A. Tahir, Department of Neurosurgery, Henry Ford Hospital, 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.
• Ossama Y. Mansour, Department of Neurology, Alexandria University Hospital, Egypt.
• et al

Recommended Citation

Dmytriw AA, Ghozy S, Sweid A, et al. International controlled study of revascularization and outcomes following COVID-positive mechanical thrombectomy. Eur J Neurol. 2022;29(11):3273-3287. doi:10.1111/ene.15493

Abstract

BACKGROUND: Previous studies suggest that the mechanisms and outcomes in COVID-19-associated stroke differ from those with non-COVID-19 strokes, but there is limited comparative evidence focusing on these populations. Therefore, we aimed 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 of 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 (mTICI 3), COVID-19 was associated with lower odds of complete revascularization [OR=0.33; 95% CI=0.23-0.48; p<0.001], which persisted on multivariable modelling with adjustment for other predictors [aOR=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 suffered higher morbidity/mortality rates.

Document Type

Article

PubMed ID

35818781