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

Sami Al Kasab^{1

2}, Eyad Almallouhi², Ali Alawieh^{3

4}, Michael R Levitt⁵, Pascal Jabbour⁶, Ahmad Sweid⁶, Robert M Starke^{7

8}, Vasu Saini⁸, Stacey Q Wolfe⁹, Kyle M Fargen⁹, Adam S Arthur^{10

11}, Nitin Goyal¹², Abhi Pandhi¹², Isabel Fragata¹³, Ilko Maier¹⁴, Charles Matouk¹⁵, Jonathan A Grossberg¹⁶, Brian M Howard^{17

18}, Peter Kan¹⁹, Muhammad Hafeez²⁰, Clemens M Schirmer²¹, R Webster Crowley²², Krishna C Joshi²³, Stavropoula I Tjoumakaris⁶, Shakeel Chowdry²⁴, William Ares²⁵, Christopher Ogilvy²⁶, Santiago Gomez-Paz²⁶, Ansaar T Rai²⁷, Maxim Mokin²⁸, Waldo Guerrero²⁸, Min S Park²⁹, Justin R Mascitelli³⁰, Albert Yoo³¹, Richard Williamson³², Andrew Walker Grande³³, Roberto Javier Crosa³⁴, Sharon Webb³⁵, Marios N Psychogios³⁶, Andrew F Ducruet³⁷, Christine A Holmstedt², Andrew J Ringer³⁸, Alejandro M Spiotta³⁹; STAR collaborators

Affiliations

¹ Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
² Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
³ Neurosurgery, Emory University, Atlanta, Georgia, USA.
⁴ Microbiology and Immunology, Medical University of South Carolina, South Carolina, USA.
⁵ Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
⁶ Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
⁷ Neurological Surgery, University of Miami Miller School of Medicine, Miami Beach, Florida, USA.
⁸ University of Miami Miller School of Medicine, Miami, Florida, USA.
⁹ Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
¹⁰ Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
¹¹ Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹² Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹³ Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
¹⁴ Neurology, University Medicine Goettingen, Goettingen, NS, Germany.
¹⁵ Neurosurgery, Yale University, New Haven, Connecticut, USA.
¹⁶ Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁷ Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁸ Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁹ Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
²⁰ Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
²¹ Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA.
²² Rush University, Chicago, Illinois, USA.
²³ Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
²⁴ North Shore University Health System, Evanston, Illinois, USA.
²⁵ Neurosurgery, North Shore University Health System, Evanston, Illinois, USA.
²⁶ Neurosurgery, BIDMC, Boston, Massachusetts, USA.
²⁷ Department of Neurointerventional Radiology, West Virginia University, Morgantown, West Virginia, USA.
²⁸ Neurosurgery, University of South Florida, Tampa, Florida, USA.
²⁹ Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
³⁰ Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
³¹ Texas Stroke Institute, Fort Worth, Texas, USA.
³² Stroke & Cerebrovascular Center, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
³³ Neurosurgery, Radiology and Neurology, University of Minnesota, Mendota Heights, Minnesota, USA.
³⁴ Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay.
³⁵ Neurosurgery, Bon Secours St Francis Hospital, Greenville, South Carolina, USA.
³⁶ Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
³⁷ Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
³⁸ Neurosurgery, Mayfield Clinic, University of Cincinnati, Cincinnati, Ohio, USA.
³⁹ Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA spiotta@musc.edu.

PMID: 32843359
PMCID: PMC7453763
DOI: 10.1136/neurintsurg-2020-016671

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

Sami Al Kasab et al. J Neurointerv Surg. 2020 Nov.

. 2020 Nov;12(11):1039-1044.

doi: 10.1136/neurintsurg-2020-016671. Epub 2020 Aug 25.

Authors

Affiliations

¹ Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
² Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
³ Neurosurgery, Emory University, Atlanta, Georgia, USA.
⁴ Microbiology and Immunology, Medical University of South Carolina, South Carolina, USA.
⁵ Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
⁶ Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
⁷ Neurological Surgery, University of Miami Miller School of Medicine, Miami Beach, Florida, USA.
⁸ University of Miami Miller School of Medicine, Miami, Florida, USA.
⁹ Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
¹⁰ Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
¹¹ Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹² Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹³ Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
¹⁴ Neurology, University Medicine Goettingen, Goettingen, NS, Germany.
¹⁵ Neurosurgery, Yale University, New Haven, Connecticut, USA.
¹⁶ Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁷ Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁸ Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
¹⁹ Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
²⁰ Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
²¹ Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA.
²² Rush University, Chicago, Illinois, USA.
²³ Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
²⁴ North Shore University Health System, Evanston, Illinois, USA.
²⁵ Neurosurgery, North Shore University Health System, Evanston, Illinois, USA.
²⁶ Neurosurgery, BIDMC, Boston, Massachusetts, USA.
²⁷ Department of Neurointerventional Radiology, West Virginia University, Morgantown, West Virginia, USA.
²⁸ Neurosurgery, University of South Florida, Tampa, Florida, USA.
²⁹ Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
³⁰ Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
³¹ Texas Stroke Institute, Fort Worth, Texas, USA.
³² Stroke & Cerebrovascular Center, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
³³ Neurosurgery, Radiology and Neurology, University of Minnesota, Mendota Heights, Minnesota, USA.
³⁴ Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay.
³⁵ Neurosurgery, Bon Secours St Francis Hospital, Greenville, South Carolina, USA.
³⁶ Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
³⁷ Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
³⁸ Neurosurgery, Mayfield Clinic, University of Cincinnati, Cincinnati, Ohio, USA.
³⁹ Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA spiotta@musc.edu.

PMID: 32843359
PMCID: PMC7453763
DOI: 10.1136/neurintsurg-2020-016671

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.

Keywords: complication; stroke; thrombectomy.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Locations of the included centers in this study.

See this image and copyright information in PMC

References

1. Organization WH Coronavirus disease 2019 (COVID-19): situation report, 117, 2020.
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International experience of mechanical thrombectomy during the COVID-19 pandemic: insights from STAR and ENRG

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical