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.
