Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study
Authors: Jabbour Pascal , Dmytriw Adam A. , Sweid Ahmad , Piotin Michel , Bekelis Kimon , Sourour Nader , Raz Eytan , 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 Frédéric , Elhorany Mahmoud , Vela-Duarte Daniel , Tahir Rizwan A. , Youssef Patrick P. , Pandey Aditya S. , Starke Robert M. , El Naamani Kareem , Abbas Rawad , Hammoud Bassel , 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 , Goyal Mayank , Wu Hannah , Cohen Jake , Turkel-Parrella David , Xavier Andrew , Waqas Muhammad , Tutino Vincent M. , 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 , Aziz-Sultan Mohamed A. , Nguyen Thanh N. , Feineigle Patricia , Patel Aman B. , Siegler James E. , Badih Khodr , Grossberg Jonathan A. , Saad Hassan , Gooch M. Reid , Herial Nabeel A. , Rosenwasser Robert H. , Tjoumakaris Stavropoula , Tiwari Ambooj 
Published: March 2022

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.