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

Adam A Dmytriw^{1

2}, Sherief Ghozy², Ahmad Sweid³, Michel Piotin⁴, Kimon Bekelis⁵, Nader Sourour⁶, Eytan Raz⁷, Daniel Vela-Duarte⁸, Italo Linfante⁸, Guilherme Dabus⁸, Max Kole⁹, Mario Martínez-Galdámez¹⁰, Shahid M Nimjee¹¹, Demetrius K Lopes¹², Ameer E Hassan¹³, Peter Kan¹⁴, Mohammad Ghorbani¹⁵, Michael R Levitt¹⁶, Simon Escalard⁴, Symeon Missios⁵, Maksim Shapiro⁷, Fréderic Clarençon⁶, Mahmoud Elhorany⁶, Rizwan A Tahir⁹, Patrick P Youssef¹¹, Aditya S Pandey¹⁷, Robert M Starke¹⁸, Kareem El Naamani³, Rawad Abbas³, Ossama Y Mansour¹⁹, Jorge Galvan¹⁰, Joshua T Billingsley¹², Abolghasem Mortazavi¹³, Melanie Walker¹⁶, Mahmoud Dibas², Fabio Settecase²⁰, Manraj K S Heran²⁰, Anna L Kuhn²¹, Ajit S Puri²¹, Bijoy K Menon²², Sanjeev Sivakumar²³, Ashkan Mowla²⁴, Salvatore D'Amato¹, Alicia M Zha²⁵, Daniel Cooke²⁶, Justin E Vranic¹, Robert W Regenhardt¹, James D Rabinov¹, Christopher J Stapleton¹, Mayank Goyal²², Hannah Wu^{27

28

29}, Jake Cohen^{27

28

29}, David Turkel-Parella^{27

28

29}, Andrew Xavier^{30

31}, Muhammad Waqas³², Vincent Tutino³², Adnan Siddiqui³², Gaurav Gupta³³, Anil Nanda³³, Priyank Khandelwal³³, Cristina Tiu³⁴, Pere C Portela³⁵, Natalia Perez de la Ossa³⁶, Xabier Urra³⁷, Mercedes de Lera³⁸, Juan F Arenillas³⁸, Marc Ribo^{39

40}, Manuel Requena^{39

40}, Mariangela Piano⁴¹, Guglielmo Pero⁴¹, Keith De Sousa⁴², Fawaz Al-Mufti⁴³, Zafar Hashim⁴⁴, Sanjeev Nayak⁴⁴, Leonardo Renieri⁴⁵, Rose Du², Mohamed A Aziz-Sultan², David Liebeskind⁴⁶, Raul G Nogueira⁴⁷, Mohamad Abdalkader⁴⁸, Thanh N Nguyen⁴⁸, Nicholas Vigilante⁴⁹, James E Siegler⁴⁹, Jonathan A Grossberg⁵⁰, Hassan Saad⁵⁰, Michael R Gooch³, Nabeel A Herial³, Robert H Rosenwasser³, Stavropoula Tjoumakaris³, Aman B Patel¹, Ambooj Tiwari^{27

28

29}, Pascal Jabbour³; North American Neurovascular COVID-19 (NAN-C) Consortium & Society of Vascular and Interventional Neurology (SVIN) Investigators

Affiliations

¹ Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA.
² Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³ Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
⁴ Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
⁵ Department of Neurosurgery, Good Samaritan Hospital Medical Center, New York, USA.
⁶ Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
⁷ Department of Radiology, New York University Langone Medical Center, New York, New York, USA.
⁸ Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA.
⁹ Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
¹⁰ Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
¹¹ Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
¹² Department of Neurosurgery, Advocate Aurora Health, Chicago, Illinois, USA.
¹³ Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA.
¹⁴ Department of Neurosurgery, UTMB, Houston, 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 Neurology, Alexandria University Hospital, Alexandria, Egypt.
²⁰ Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
²¹ Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA.
²² Calgary Stroke Program, Cumming School of Medicine, Calgary, Alberta, Canada.
²³ Department of Medicine (Neurology), Prisma Health Upstate, USC, Greenville, South Carolina, USA.
²⁴ Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA.
²⁵ Department of Neurology, UT Health Science Center, Houston, Texas, USA.
²⁶ Department of Neurointerventional Radiology, San Francisco General Hospital, San Francisco, California, USA.
²⁷ Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA.
²⁸ Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA.
²⁹ Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA.
³⁰ Department of Neurology, Sinai Grace Hospital, Detroit, Michigan, USA.
³¹ Department of Neurology, St. Joseph Mercy Health, Ann Arbor, Michigan, USA.
³² Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA.
³³ Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.
³⁴ Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
³⁵ Department of Neurology, Hospital Universitari, Bellvitge, Barcelona, Spain.
³⁶ Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, Barcelona, Spain.
³⁷ Department of Neurology, Hospital Clínic, Barcelona, Spain.
³⁸ Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain.
³⁹ Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain.
⁴⁰ Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain.
⁴¹ Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
⁴² Department of Neurology, Eastern Region, Northwell Health, New York, New York, USA.
⁴³ Department of Neurology, Radiology, and Neurosurgery, Westchester Medical Center at NY Medical College, Valhalla, New York, USA.
⁴⁴ Department of Radiology, University Hospital of North Midlands, Stoke-on-Trent, UK.
⁴⁵ Department of Radiology, Neurovascular Unit, Careggi University Hospital, Florence, Italy.
⁴⁶ Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, USA.
⁴⁷ Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA.
⁴⁸ Departments of Neurology and Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
⁴⁹ Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA.
⁵⁰ Department of Neurosurgery|, Emory University, Atlanta, Georgia, USA.

PMID: 35818781
PMCID: PMC9349405
DOI: 10.1111/ene.15493

Multicenter Study

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

Adam A Dmytriw et al. Eur J Neurol. 2022 Nov.

. 2022 Nov;29(11):3273-3287.

doi: 10.1111/ene.15493. Epub 2022 Jul 26.

Authors

Affiliations

¹ Neuroendovascular Program, Mass General Brigham Partners, Harvard Medical School, Boston, Massachusetts, USA.
² Neuroradiology & Neurosurgery Services, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³ Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
⁴ Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.
⁵ Department of Neurosurgery, Good Samaritan Hospital Medical Center, New York, USA.
⁶ Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
⁷ Department of Radiology, New York University Langone Medical Center, New York, New York, USA.
⁸ Department of Interventional Neuroradiology & Neuroendovascular Surgery, Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida, USA.
⁹ Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
¹⁰ Department of Interventional Neuroradiology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
¹¹ Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
¹² Department of Neurosurgery, Advocate Aurora Health, Chicago, Illinois, USA.
¹³ Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA.
¹⁴ Department of Neurosurgery, UTMB, Houston, 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 Neurology, Alexandria University Hospital, Alexandria, Egypt.
²⁰ Division of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
²¹ Division of Neurointerventional Radiology, Department of Radiology, UMass Memorial Medical Center, Worcester, Massachusetts, USA.
²² Calgary Stroke Program, Cumming School of Medicine, Calgary, Alberta, Canada.
²³ Department of Medicine (Neurology), Prisma Health Upstate, USC, Greenville, South Carolina, USA.
²⁴ Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA.
²⁵ Department of Neurology, UT Health Science Center, Houston, Texas, USA.
²⁶ Department of Neurointerventional Radiology, San Francisco General Hospital, San Francisco, California, USA.
²⁷ Department of Neurology, Brookdale University Hospital, Brooklyn, New York, USA.
²⁸ Department of Neurology, Jamaica Medical Center, Richmond Hill, New York, USA.
²⁹ Department of Neurology, NYU Lutheran Hospital, Brooklyn, New York, USA.
³⁰ Department of Neurology, Sinai Grace Hospital, Detroit, Michigan, USA.
³¹ Department of Neurology, St. Joseph Mercy Health, Ann Arbor, Michigan, USA.
³² Department of Neurosurgery, University of New York at Buffalo, Buffalo, New York, USA.
³³ Department of Neurology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.
³⁴ Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
³⁵ Department of Neurology, Hospital Universitari, Bellvitge, Barcelona, Spain.
³⁶ Stroke Unit, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Carretera Canyet s/n, Barcelona, Spain.
³⁷ Department of Neurology, Hospital Clínic, Barcelona, Spain.
³⁸ Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain.
³⁹ Stroke Unit, Department of Neurology, Vall d'Hebron Research Institute, Barcelona, Spain.
⁴⁰ Departament de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain.
⁴¹ Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
⁴² Department of Neurology, Eastern Region, Northwell Health, New York, New York, USA.
⁴³ Department of Neurology, Radiology, and Neurosurgery, Westchester Medical Center at NY Medical College, Valhalla, New York, USA.
⁴⁴ Department of Radiology, University Hospital of North Midlands, Stoke-on-Trent, UK.
⁴⁵ Department of Radiology, Neurovascular Unit, Careggi University Hospital, Florence, Italy.
⁴⁶ Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, USA.
⁴⁷ Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA.
⁴⁸ Departments of Neurology and Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
⁴⁹ Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA.
⁵⁰ Department of Neurosurgery|, Emory University, Atlanta, Georgia, USA.

PMID: 35818781
PMCID: PMC9349405
DOI: 10.1111/ene.15493

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.

Keywords: COVID-19; large vessel occlusion; morbidity; mortality; stroke.

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Conflict of interest statement

There are no relevant conflicts of interest.

References

1. Worldometer . COVID‐19 Coronavirus Pandemic – United States. Accessed 10 August 2021. https://www.worldometers.info/coronavirus/country/us/
1. WHO . Accessed 8 November, 2021. https://www.who.int/emergencies/diseases/novel‐coronavirus‐2019?adgroups...
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International controlled study of revascularization and outcomes following COVID-positive mechanical thrombectomy

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

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