Multicenter Study

. 2022 Jun 1;90(6):725-733.

doi: 10.1227/neu.0000000000001902. Epub 2022 Mar 7.

Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study

Pascal Jabbour¹, Adam A Dmytriw², Ahmad Sweid¹, Michel Piotin³, Kimon Bekelis⁴, Nader Sourour⁵, Eytan Raz⁶, Italo Linfante⁷, Guilherme Dabus⁷, Max Kole⁸, Mario Martínez-Galdámez⁹, Shahid M Nimjee¹⁰, Demetrius K Lopes¹¹, Ameer E Hassan¹², Peter Kan^{13

14}, Mohammad Ghorbani¹⁵, Michael R Levitt¹⁶, Simon Escalard³, Symeon Missios⁴, Maksim Shapiro⁶, Frédéric Clarençon⁵, Mahmoud Elhorany⁵, Daniel Vela-Duarte⁷, Rizwan A Tahir⁸, Patrick P Youssef¹⁰, Aditya S Pandey¹⁷, Robert M Starke¹⁸, Kareem El Naamani¹, Rawad Abbas¹, Bassel Hammoud¹⁹, Ossama Y Mansour²⁰, Jorge Galvan⁹, Joshua T Billingsley¹¹, Abolghasem Mortazavi¹², Melanie Walker²¹, Mahmoud Dibas², Fabio Settecase²², Manraj K S Heran²², Anna L Kuhn²³, Ajit S Puri²³, Bijoy K Menon²⁴, Sanjeev Sivakumar¹⁸, Ashkan Mowla²⁵, Salvatore D'Amato², Alicia M Zha²⁶, Daniel Cooke²⁷, Mayank Goyal²⁴, Hannah Wu^{28

29

30}, Jake Cohen^{28

29

30}, David Turkel-Parrella^{28

29

30}, Andrew Xavier^{31

32}, Muhammad Waqas³³, Vincent M Tutino³³, Adnan Siddiqui³³, Gaurav Gupta³⁴, Anil Nanda³⁴, Priyank Khandelwal³⁴, Cristina Tiu³⁵, Pere C Portela³⁶, Natalia Perez de la Ossa³⁷, Xabier Urra³⁸, Mercedes de Lera³⁹, Juan F Arenillas³⁹, Marc Ribo^{40

41}, Manuel Requena^{40

41}, Mariangela Piano³⁵, Guglielmo Pero³⁵, Keith De Sousa³⁶, Fawaz Al-Mufti³⁷, Zafar Hashim⁴², Sanjeev Nayak³⁸, Leonardo Renieri⁴³, Mohamed A Aziz-Sultan², Thanh N Nguyen⁴⁴, Patricia Feineigle⁴¹, Aman B Patel², James E Siegler⁴¹, Khodr Badih³⁵, Jonathan A Grossberg³⁶, Hassan Saad³⁶, M Reid Gooch¹, Nabeel A Herial¹, Robert H Rosenwasser¹, Stavropoula Tjoumakaris¹, Ambooj Tiwari^{28

29

30}

Affiliations

¹ Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
² Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA.
³ Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
⁴ Department of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA.
⁵ Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
⁶ Department of Radiology, New York University Langone Medical Center, New York, New York, USA.
⁷ Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA.
⁸ Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
⁹ Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
¹⁰ Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
¹¹ Department of Neurosurgery, Advocate Aurora Health, Chicago, Illinois, USA.
¹² Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA.
¹³ Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
¹⁴ Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA.
¹⁵ Department of Neurosurgery, Firoozgar Hospital, Tehran, Iran.
¹⁶ Departments of Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA.
¹⁷ Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
¹⁸ Department of Neurosurgery & Neuroradiology, University of Miami & Jackson Memorial Hospital, Miami, Florida, USA.
¹⁹ Department of Biomedical Engineering, American University of Beirut, Beirut, Lebanon.
²⁰ Department of Neurology and Neuroradiology, Alexandria University Hospital, Al Attarin, Egypt.
²¹ Departments of Neurological Surgery and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA.
²² Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, USA.
²³ Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA.
²⁴ Calgary Stroke Program, Cumming School of Medicine, Calgary, Alberta, Canada.
²⁵ Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA.
²⁶ Department of Neurology, UT Health Science Center, Houston, Texas, USA.
²⁷ Department of Neurointerventional Radiology, San Francisco General Hospital, San Francisco, California, USA.
²⁸ Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA.
²⁹ Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA.
³⁰ Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA.
³¹ Department of Neurology, Sinai Grace Hospital, Detroit, Michigan, USA.
³² Department of Neurology, St. Joseph Mercy Health, Ann Arbor, Michigan, USA.
³³ Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA.
³⁴ Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.
³⁵ Department of Physics, University of Toronto, Toronto, Ontario, Canada.
³⁶ Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
³⁷ Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
³⁸ Department of Neurology, Hospital Clínic, Barcelona, Spain.
³⁹ Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain.
⁴⁰ Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain.
⁴¹ Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA.
⁴² Department of Radiology, University Hospital of North Midlands, Stoke-on-Trent, UK.
⁴³ Department of Radiology, Neurovascular Unit, Careggi University Hospital, Florence, Italy.
⁴⁴ Departments of Neurology and Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.

PMID: 35238817
PMCID: PMC9514728
DOI: 10.1227/neu.0000000000001902

Multicenter Study

Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study

Pascal Jabbour et al. Neurosurgery. 2022.

. 2022 Jun 1;90(6):725-733.

doi: 10.1227/neu.0000000000001902. Epub 2022 Mar 7.

Authors

Affiliations

¹ Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
² Interventional Neuroradiology & Endovascular Neurosurgery Service, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA.
³ Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
⁴ Department of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, New York, USA.
⁵ Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
⁶ Department of Radiology, New York University Langone Medical Center, New York, New York, USA.
⁷ Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA.
⁸ Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
⁹ Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
¹⁰ Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
¹¹ Department of Neurosurgery, Advocate Aurora Health, Chicago, Illinois, USA.
¹² Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA.
¹³ Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
¹⁴ Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA.
¹⁵ Department of Neurosurgery, Firoozgar Hospital, Tehran, Iran.
¹⁶ Departments of Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA.
¹⁷ Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
¹⁸ Department of Neurosurgery & Neuroradiology, University of Miami & Jackson Memorial Hospital, Miami, Florida, USA.
¹⁹ Department of Biomedical Engineering, American University of Beirut, Beirut, Lebanon.
²⁰ Department of Neurology and Neuroradiology, Alexandria University Hospital, Al Attarin, Egypt.
²¹ Departments of Neurological Surgery and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA.
²² Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, USA.
²³ Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA.
²⁴ Calgary Stroke Program, Cumming School of Medicine, Calgary, Alberta, Canada.
²⁵ Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA.
²⁶ Department of Neurology, UT Health Science Center, Houston, Texas, USA.
²⁷ Department of Neurointerventional Radiology, San Francisco General Hospital, San Francisco, California, USA.
²⁸ Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA.
²⁹ Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA.
³⁰ Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA.
³¹ Department of Neurology, Sinai Grace Hospital, Detroit, Michigan, USA.
³² Department of Neurology, St. Joseph Mercy Health, Ann Arbor, Michigan, USA.
³³ Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA.
³⁴ Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.
³⁵ Department of Physics, University of Toronto, Toronto, Ontario, Canada.
³⁶ Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
³⁷ Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
³⁸ Department of Neurology, Hospital Clínic, Barcelona, Spain.
³⁹ Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain.
⁴⁰ Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain.
⁴¹ Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA.
⁴² Department of Radiology, University Hospital of North Midlands, Stoke-on-Trent, UK.
⁴³ Department of Radiology, Neurovascular Unit, Careggi University Hospital, Florence, Italy.
⁴⁴ Departments of Neurology and Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.

PMID: 35238817
PMCID: PMC9514728
DOI: 10.1227/neu.0000000000001902

Abstract

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.

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In Reply: Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study.
El Naamani K, Jabbour P. El Naamani K, et al. Neurosurgery. 2022 Oct 1;91(4):e115-e116. doi: 10.1227/neu.0000000000002103. Epub 2022 Aug 4. Neurosurgery. 2022. PMID: 35916580 No abstract available.
Letter: Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study.
Wang L. Wang L. Neurosurgery. 2022 Oct 1;91(4):e113-e114. doi: 10.1227/neu.0000000000002102. Epub 2022 Aug 4. Neurosurgery. 2022. PMID: 35916594 No abstract available.

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Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study

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Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study

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