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Author Notes:

Correspondence to Dr Alejandro M Spiotta, Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA; spiotta@musc.edu

SAK and EA are joint first authors.

See publication for full list of authors and contributors.

Competing interests: None declared.

Subjects:

Research Funding:

The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

Keywords:

  • complication
  • stroke
  • thrombectomy
  • Aged
  • Aged, 80 and over
  • Anesthesia, General
  • Coronavirus Infections
  • Endovascular Procedures
  • Female
  • Hospital Mortality
  • Humans
  • Independent Living
  • Linear Models
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral
  • Prospective Studies
  • Reperfusion
  • Stroke
  • Thrombectomy
  • Treatment Outcome
  • Workflow

International experience of mechanical thrombectomy during the COVID-19 pandemic: Insights from STAR and ENRG

Tools:

Journal Title:

Journal of NeuroInterventional Surgery

Volume:

Volume 12, Number 11

Publisher:

, Pages 1039-1044

Type of Work:

Article | Final Publisher PDF

Abstract:

Background: In response to the COVID-19 pandemic, many centers altered stroke triage protocols for the protection of their providers. However, the effect of workflow changes on stroke patients receiving mechanical thrombectomy (MT) has not been systematically studied. Methods: A prospective international study was launched at the initiation of the COVID-19 pandemic. All included centers participated in the Stroke Thrombectomy and Aneurysm Registry (STAR) and Endovascular Neurosurgery Research Group (ENRG). Data was collected during the peak months of the COVID-19 surge at each site. Collected data included patient and disease characteristics. A generalized linear model with logit link function was used to estimate the effect of general anesthesia (GA) on in-hospital mortality and discharge outcome controlling for confounders. Results: 458 patients and 28 centers were included from North America, South America, and Europe. Five centers were in high-COVID burden counties (HCC) in which 9/104 (8.7%) of patients were positive for COVID-19 compared with 4/354 (1.1%) in low-COVID burden counties (LCC) (P<0.001). 241 patients underwent pre-procedure GA. Compared with patients treated awake, GA patients had longer door to reperfusion time (138 vs 100 min, P=<0.001). On multivariate analysis, GA was associated with higher probability of in-hospital mortality (RR 1.871, P=0.029) and lower probability of functional independence at discharge (RR 0.53, P=0.015). Conclusion: We observed a low rate of COVID-19 infection among stroke patients undergoing MT in LCC. Overall, more than half of the patients underwent intubation prior to MT, leading to prolonged door to reperfusion time, higher in-hospital mortality, and lower likelihood of functional independence at discharge.

Copyright information:

© Author(s) (or their employer(s)) 2020. No commercial re-use.

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