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

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.