Mechanical thrombectomy for acute ischemic stroke in COVID-19 patients: multicenter experience in 111 cases.

Abstract

BACKGROUND:

Data on the frequency and outcome of mechanical thrombectomy (MT) for large vessel occlusion (LVO) in patients with COVID-19 is limited. Addressing this subject, we report our multicenter experience.

METHODS:

A retrospective cohort study was performed of consecutive acute stroke patients with COVID-19 infection treated with MT at 26 tertiary care centers between January 2020 and November 2021. Baseline demographics, angiographic outcome and clinical outcome evaluated by the modified Rankin Scale (mRS) at discharge and 90 days were noted.

RESULTS:

We identified 111 out of 11 365 (1%) patients with acute or subsided COVID-19 infection who underwent MT due to LVO. Cardioembolic events were the most common etiology for LVO (38.7%). Median baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score were 16 (IQR 11.5-20) and 9 (IQR 7-10), respectively. Successful reperfusion (mTICI ≥2b) was achieved in 97/111 (87.4%) patients and 46/111 (41.4%) patients were reperfused completely. The procedure-related complication rate was 12.6% (14/111). Functional independence was achieved in 20/108 (18.5%) patients at discharge and 14/66 (21.2%) at 90 days follow-up. The in-hospital mortality rate was 30.6% (33/108). In the subgroup analysis, patients with severe acute COVID-19 infection requiring intubation had a mortality rate twice as high as patients with mild or moderate acute COVID-19 infection. Acute respiratory failure requiring ventilation and time interval from symptom onset to groin puncture were independent predictors for an unfavorable outcome in a logistic regression analysis.

CONCLUSION:

Our study showed a poor clinical outcome and high mortality, especially in patients with severe acute COVID-19 infection undergoing MT due to LVO.

• Authors: Hanna Styczen, Volker Maus, Lukas Goertz, Martin Köhrmann, Christoph Kleinschnitz, Sebastian Fischer, Markus Möhlenbruch, Iris Mühlen, Bernd Kallmünzer, Franziska Dorn, Asadeh Lakghomi, Matthias Gawlitza, Daniel Kaiser, Joachim Klisch, Donald Lobsien, Stefan Rohde, Gisa Ellrichmann, Daniel Behme, Maximilian Thormann, Fabian Flottmann, Laurens Winkelmeier, Elke R Gizewski, Lukas Mayer-Suess, Tobias Boeckh-Behrens, Isabelle Riederer, Randolf Klingebiel, Björn Berger, Martin Schlunz-Hendann, Dominik Grieb, Ali Khanafer, Richard du Mesnil de Rochemont, Christophe Arendt, Jens Altenbernd, Jan-Ulrich Schlump, Adrian Ringelstein, Vivian Jean Marcel Sanio, Christian Loehr, Agnes Maria Dahlke, Carolin Brockmann, Sebastian Reder, Ulrich Sure, Yan Li, Ruben Mühl-Benninghaus, Thomas Rodt, Kai Kallenberg, Alexandru Durutya, Mohamed Elsharkawy, Paul Stracke, Mathias Gerhard Schumann, Alexander Bock, Omid Nikoubashman, Martin Wiesmann, Hans Henkes, Pascal J Mosimann, René Chapot, Michael Forsting, Cornelius Deuschl
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 14 Issue 9 Pg. 858-862 (Sep 2022) ISSN: 1759-8486 [Electronic] England
• PMID: 35292572 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Brain Ischemia (complications, diagnostic imaging, therapy)
• COVID-19 (complications)
• Humans
• Ischemic Stroke (diagnostic imaging, surgery)
• Retrospective Studies
• Stroke (diagnostic imaging, etiology, surgery)
• Thrombectomy (adverse effects)
• Treatment Outcome