tetano
Editor, Senior Moderator
Neurosurgery
. 2022 Mar 7.
doi: 10.1227/NEU.0000000000001902. Online ahead of print.
Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study
Pascal Jabbour[SUP] 1 [/SUP], Adam A Dmytriw[SUP] 2 [/SUP], Ahmad Sweid[SUP] 1 [/SUP], Michel Piotin[SUP] 3 [/SUP], Kimon Bekelis[SUP] 4 [/SUP], Nader Sourour[SUP] 5 [/SUP], Eytan Raz[SUP] 6 [/SUP], Italo Linfante[SUP] 7 [/SUP], Guilherme Dabus[SUP] 7 [/SUP], Max Kole[SUP] 8 [/SUP], Mario Martínez-Galdámez[SUP] 9 [/SUP], Shahid M Nimjee[SUP] 10 [/SUP], Demetrius K Lopes[SUP] 11 [/SUP], Ameer E Hassan[SUP] 12 [/SUP], Peter Kan[SUP] 13 14 [/SUP], Mohammad Ghorbani[SUP] 15 [/SUP], Michael R Levitt[SUP] 16 [/SUP], Simon Escalard[SUP] 3 [/SUP], Symeon Missios[SUP] 4 [/SUP], Maksim Shapiro[SUP] 6 [/SUP], Frédéric Clarençon[SUP] 5 [/SUP], Mahmoud Elhorany[SUP] 5 [/SUP], Daniel Vela-Duarte[SUP] 7 [/SUP], Rizwan A Tahir[SUP] 8 [/SUP], Patrick P Youssef[SUP] 10 [/SUP], Aditya S Pandey[SUP] 17 [/SUP], Robert M Starke[SUP] 18 [/SUP], Kareem El Naamani[SUP] 1 [/SUP], Rawad Abbas[SUP] 1 [/SUP], Bassel Hammoud[SUP] 19 [/SUP], Ossama Y Mansour[SUP] 20 [/SUP], Jorge Galvan[SUP] 9 [/SUP], Joshua T Billingsley[SUP] 11 [/SUP], Abolghasem Mortazavi[SUP] 12 [/SUP], Melanie Walker[SUP] 21 [/SUP], Mahmoud Dibas[SUP] 2 [/SUP], Fabio Settecase[SUP] 22 [/SUP], Manraj K S Heran[SUP] 22 [/SUP], Anna L Kuhn[SUP] 23 [/SUP], Ajit S Puri[SUP] 23 [/SUP], Bijoy K Menon[SUP] 24 [/SUP], Sanjeev Sivakumar[SUP] 18 [/SUP], Ashkan Mowla[SUP] 25 [/SUP], Salvatore D'Amato[SUP] 2 [/SUP], Alicia M Zha[SUP] 26 [/SUP], Daniel Cooke[SUP] 27 [/SUP], Mayank Goyal[SUP] 24 [/SUP], Hannah Wu[SUP] 28 29 30 [/SUP], Jake Cohen[SUP] 28 29 30 [/SUP], David Turkel-Parrella[SUP] 28 29 30 [/SUP], Andrew Xavier[SUP] 31 32 [/SUP], Muhammad Waqas[SUP] 33 [/SUP], Vincent M Tutino[SUP] 33 [/SUP], Adnan Siddiqui[SUP] 33 [/SUP], Gaurav Gupta[SUP] 34 [/SUP], Anil Nanda[SUP] 34 [/SUP], Priyank Khandelwal[SUP] 34 [/SUP], Cristina Tiu[SUP] 35 [/SUP], Pere C Portela[SUP] 36 [/SUP], Natalia Perez de la Ossa[SUP] 37 [/SUP], Xabier Urra[SUP] 38 [/SUP], Mercedes de Lera[SUP] 39 [/SUP], Juan F Arenillas[SUP] 39 [/SUP], Marc Ribo[SUP] 40 41 [/SUP], Manuel Requena[SUP] 40 41 [/SUP], Mariangela Piano[SUP] 35 [/SUP], Guglielmo Pero[SUP] 35 [/SUP], Keith De Sousa[SUP] 36 [/SUP], Fawaz Al-Mufti[SUP] 37 [/SUP], Zafar Hashim[SUP] 42 [/SUP], Sanjeev Nayak[SUP] 38 [/SUP], Leonardo Renieri[SUP] 43 [/SUP], Mohamed A Aziz-Sultan[SUP] 2 [/SUP], Thanh N Nguyen[SUP] 44 [/SUP], Patricia Feineigle[SUP] 41 [/SUP], Aman B Patel[SUP] 2 [/SUP], James E Siegler[SUP] 41 [/SUP], Khodr Badih[SUP] 35 [/SUP], Jonathan A Grossberg[SUP] 36 [/SUP], Hassan Saad[SUP] 36 [/SUP], M Reid Gooch[SUP] 1 [/SUP], Nabeel A Herial[SUP] 1 [/SUP], Robert H Rosenwasser[SUP] 1 [/SUP], Stavropoula Tjoumakaris[SUP] 1 [/SUP], Ambooj Tiwari[SUP] 28 29 30 [/SUP]
Affiliations
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.
. 2022 Mar 7.
doi: 10.1227/NEU.0000000000001902. Online ahead of print.
Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study
Pascal Jabbour[SUP] 1 [/SUP], Adam A Dmytriw[SUP] 2 [/SUP], Ahmad Sweid[SUP] 1 [/SUP], Michel Piotin[SUP] 3 [/SUP], Kimon Bekelis[SUP] 4 [/SUP], Nader Sourour[SUP] 5 [/SUP], Eytan Raz[SUP] 6 [/SUP], Italo Linfante[SUP] 7 [/SUP], Guilherme Dabus[SUP] 7 [/SUP], Max Kole[SUP] 8 [/SUP], Mario Martínez-Galdámez[SUP] 9 [/SUP], Shahid M Nimjee[SUP] 10 [/SUP], Demetrius K Lopes[SUP] 11 [/SUP], Ameer E Hassan[SUP] 12 [/SUP], Peter Kan[SUP] 13 14 [/SUP], Mohammad Ghorbani[SUP] 15 [/SUP], Michael R Levitt[SUP] 16 [/SUP], Simon Escalard[SUP] 3 [/SUP], Symeon Missios[SUP] 4 [/SUP], Maksim Shapiro[SUP] 6 [/SUP], Frédéric Clarençon[SUP] 5 [/SUP], Mahmoud Elhorany[SUP] 5 [/SUP], Daniel Vela-Duarte[SUP] 7 [/SUP], Rizwan A Tahir[SUP] 8 [/SUP], Patrick P Youssef[SUP] 10 [/SUP], Aditya S Pandey[SUP] 17 [/SUP], Robert M Starke[SUP] 18 [/SUP], Kareem El Naamani[SUP] 1 [/SUP], Rawad Abbas[SUP] 1 [/SUP], Bassel Hammoud[SUP] 19 [/SUP], Ossama Y Mansour[SUP] 20 [/SUP], Jorge Galvan[SUP] 9 [/SUP], Joshua T Billingsley[SUP] 11 [/SUP], Abolghasem Mortazavi[SUP] 12 [/SUP], Melanie Walker[SUP] 21 [/SUP], Mahmoud Dibas[SUP] 2 [/SUP], Fabio Settecase[SUP] 22 [/SUP], Manraj K S Heran[SUP] 22 [/SUP], Anna L Kuhn[SUP] 23 [/SUP], Ajit S Puri[SUP] 23 [/SUP], Bijoy K Menon[SUP] 24 [/SUP], Sanjeev Sivakumar[SUP] 18 [/SUP], Ashkan Mowla[SUP] 25 [/SUP], Salvatore D'Amato[SUP] 2 [/SUP], Alicia M Zha[SUP] 26 [/SUP], Daniel Cooke[SUP] 27 [/SUP], Mayank Goyal[SUP] 24 [/SUP], Hannah Wu[SUP] 28 29 30 [/SUP], Jake Cohen[SUP] 28 29 30 [/SUP], David Turkel-Parrella[SUP] 28 29 30 [/SUP], Andrew Xavier[SUP] 31 32 [/SUP], Muhammad Waqas[SUP] 33 [/SUP], Vincent M Tutino[SUP] 33 [/SUP], Adnan Siddiqui[SUP] 33 [/SUP], Gaurav Gupta[SUP] 34 [/SUP], Anil Nanda[SUP] 34 [/SUP], Priyank Khandelwal[SUP] 34 [/SUP], Cristina Tiu[SUP] 35 [/SUP], Pere C Portela[SUP] 36 [/SUP], Natalia Perez de la Ossa[SUP] 37 [/SUP], Xabier Urra[SUP] 38 [/SUP], Mercedes de Lera[SUP] 39 [/SUP], Juan F Arenillas[SUP] 39 [/SUP], Marc Ribo[SUP] 40 41 [/SUP], Manuel Requena[SUP] 40 41 [/SUP], Mariangela Piano[SUP] 35 [/SUP], Guglielmo Pero[SUP] 35 [/SUP], Keith De Sousa[SUP] 36 [/SUP], Fawaz Al-Mufti[SUP] 37 [/SUP], Zafar Hashim[SUP] 42 [/SUP], Sanjeev Nayak[SUP] 38 [/SUP], Leonardo Renieri[SUP] 43 [/SUP], Mohamed A Aziz-Sultan[SUP] 2 [/SUP], Thanh N Nguyen[SUP] 44 [/SUP], Patricia Feineigle[SUP] 41 [/SUP], Aman B Patel[SUP] 2 [/SUP], James E Siegler[SUP] 41 [/SUP], Khodr Badih[SUP] 35 [/SUP], Jonathan A Grossberg[SUP] 36 [/SUP], Hassan Saad[SUP] 36 [/SUP], M Reid Gooch[SUP] 1 [/SUP], Nabeel A Herial[SUP] 1 [/SUP], Robert H Rosenwasser[SUP] 1 [/SUP], Stavropoula Tjoumakaris[SUP] 1 [/SUP], Ambooj Tiwari[SUP] 28 29 30 [/SUP]
Affiliations
- PMID: 35238817
- 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.