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

• Type of Material: Article
• Authors: Adam A Dmytriw, Harvard Medical School; Sherief Ghozy, Harvard Medical School; Ahmad Sweid, Thomas Jefferson University Hospital; Michel Piotin, Rothschild Foundation Hospital; Kimon Bekelis, Good Samaritan Hospital Medical Center; Nader Sourour, Pitié‐Salpêtrière Hospital; Eytan Raz, New York University; Daniel Vela-Duarte, Baptist Hospital Miami; Italo Linfante, Baptist Hospital Miami; Guilherme Dabus, Baptist Hospital Miami; Max Kole, Henry Ford Hospital; Mario Martínez‐Galdámez, Hospital Clinico Universitario de Valladolid; Shahid M Nimjee, Ohio State University; Demetrius K Lopes, Advocate Aurora Health; Ameer E Hassan, University of Texas Rio Grande Valley; Peter Kan, UTMB, Houston Texas; Mohammad Ghorbani, Firoozgar Hospital; Michael R Levitt, University of Washington; Simon Escalard, Rothschild Foundation Hospital; Symeon Missios, Good Samaritan Hospital Medical Center; Maksim Shapiro, New York University; Fréderic Clarençon, Pitié‐Salpêtrière Hospital; Mahmoud Elhorany, Pitié‐Salpêtrière Hospital; Rizwan A Tahir, Henry Ford Hospital; Patrick P Youssef, Ohio State University; Aditya S Pandey, University of Michigan; Robert M Starke, University of Miami; Kareem El Naamani, Thomas Jefferson University Hospital; Rawad Abbas, Thomas Jefferson University Hospital; Ossama Y Mansour, Alexandria University Hospital; Jorge Galvan, Hospital Clinico Universitario de Valladolid; Joshua T Billingsley, Advocate Aurora Health; Abolhasem Mortazavi, University of Texas Rio Grande Valley; Melanie Walker, University of Washington; Mahmoud Dibas, Harvard Medical School; Fabio Settecase, University of British Columbia; Manraj KS Heran, University of British Columbia; Anna L Kuhn, UMass Memorial Medical Center; Ajit S Puri, UMass Memorial Medical Center; Bijoy K Menon, Cumming School of Medicine; Sanjeev Sivakumar, Prisma Health Upstate, USC; Ashkan Mowla, University of Southern California; Salvatore D'Amato, Harvard Medical School; Alicia M Zha, UT Health Science Center; Daniel Cooke, San Francisco General Hospital; Justin E Vranic, Harvard Medical School; Robert W Regenhardt, Harvard Medical School; James D Rabinov, Harvard Medical School; Christopher J Stapleton, Harvard Medical School; Mayank Goyal, Cumming School of Medicine; Hannah Wu, Brookdale University Hospital; Jake Cohen, Brookdale University Hospital; David Turkel-Parella, Brookdale University Hospital; Andrew Xavier, Sinai Grace Hospital; Muhammad Waqas, University of New York at Buffalo; Vincent Tutino, University of New York at Buffalo; Adnan Siddiqui, University of New York at Buffalo; Gaurav Gupta, Robert Wood Johnson Univ Hosp; Anil Nanda, Robert Wood Johnson Univ Hosp; Priyank Khandelwal, Robert Wood Johnson Univ Hosp; Cristina Tiu, University of Medicine and Pharmacy, Bucharest; Pere C Portela, Hospital Universitari, Spain; Natalia Perez de la Ossa, Hospital Universitari Germans Trias i Pujol; Xabier Urra, Hospital Clínic, Barcelona; Mercedes de Lera, Hospital Clínico Universitario, Spain; Juan F Arenillas, Hospital Clínico Universitario, Spain; Marc Ribo, Vall d'Hebron Research Institute, Spain; Manuel Requena, Vall d'Hebron Research Institute, Spain; Mariangela Piano, ASST Grande Osped Metropolitano Niguarda; Guglielmo Pero, ASST Grande Osped Metropolitano Niguarda; Keith De Sousa, Northwell Health, New York; Fawaz Al-Mufti, NY Medical College; Zafar Hashim, University Hospital of North Midlands; Sanjeev Nayak, University Hospital of North Midlands; Leonardo Renieri, Careggi University Hospital; Rose Du, Harvard Medical School; Mohamed A Aziz-Sultan, Harvard Medical School; David Liebeskind, Ronald Reagan UCLA Med Ctr; Raul Nogueira, Emory University; Mohamad Abdalkader, Boston University; Thanh N Nguyen, Boston University; Nicholas Vigilante, Cooper University Hospital; James E Siegler, Cooper University Hospital; Jonathan Grossberg, Emory University; Hassan Saad, Emory University; Michael R Gooch, Thomas Jefferson University Hospital; Nabeel A Herial, Thomas Jefferson University Hospital; Robert H Rosenwasser, Thomas Jefferson University Hospital; Stavropoula Tjoumakaris, Thomas Jefferson University Hospital; Aman B Patel, Harvard Medical School; Ambooj Tiwari, Brookdale University Hospital; Pascal Jabbour, Thomas Jefferson University Hospital
• Language: English
• Date: 2022-07-26
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2022 European Academy of Neurology.
• Final Published Version (URL): http://dx.doi.org/10.1111/ene.15493
• Title of Journal or Parent Work: EUROPEAN JOURNAL OF NEUROLOGY
• Volume: 29
• Issue: 11
• Start Page: 3273
• End Page: 3287
• Grant/Funding Information: This research received no grant from any funding agency in public, commercial, or not‐for‐profit sectors.
• Keywords: stroke; Neurosciences & Neurology; COVID-19; COMPLICATIONS; Science & Technology; Life Sciences & Biomedicine; ACE2; mortality; ACUTE ISCHEMIC-STROKE; Clinical Neurology; morbidity; Neurosciences; BRAIN; large vessel occlusion; TISSUE DISTRIBUTION; ACUTE HYPERGLYCEMIA; INFECTION; CLASSIFICATION; SARS CORONAVIRUS; ANGIOTENSIN-(1-7)
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Pharmacy

Abstract

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.