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 Kan13,14, 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 Wu28,29,30, Jake Cohen28,29,30, David Turkel-Parrella28,29,30, Andrew Xavier31,32, 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 Ribo40,41, Manuel Requena40,41, 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 Tiwari28,29,30. 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.
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.
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.
Authors: Pratyaksh K Srivastava; Shuaiqi Zhang; Ying Xian; Hanzhang Xu; Christine Rutan; Heather M Alger; Jason Walchok; Joseph Williams; James A de Lemos; Marquita R Decker-Palmer; Brooke Alhanti; Mitchell S V Elkind; Steve R Messé; Eric E Smith; Lee H Schwamm; Gregg C Fonarow Journal: Stroke Date: 2021-03-17 Impact factor: 7.914
Authors: Leora R Feldstein; Erica B Rose; Steven M Horwitz; Jennifer P Collins; Margaret M Newhams; Mary Beth F Son; Jane W Newburger; Lawrence C Kleinman; Sabrina M Heidemann; Amarilis A Martin; Aalok R Singh; Simon Li; Keiko M Tarquinio; Preeti Jaggi; Matthew E Oster; Sheemon P Zackai; Jennifer Gillen; Adam J Ratner; Rowan F Walsh; Julie C Fitzgerald; Michael A Keenaghan; Hussam Alharash; Sule Doymaz; Katharine N Clouser; John S Giuliano; Anjali Gupta; Robert M Parker; Aline B Maddux; Vinod Havalad; Stacy Ramsingh; Hulya Bukulmez; Tamara T Bradford; Lincoln S Smith; Mark W Tenforde; Christopher L Carroll; Becky J Riggs; Shira J Gertz; Ariel Daube; Amanda Lansell; Alvaro Coronado Munoz; Charlotte V Hobbs; Kimberly L Marohn; Natasha B Halasa; Manish M Patel; Adrienne G Randolph Journal: N Engl J Med Date: 2020-06-29 Impact factor: 91.245
Authors: Zsuzsanna Varga; Andreas J Flammer; Peter Steiger; Martina Haberecker; Rea Andermatt; Annelies S Zinkernagel; Mandeep R Mehra; Reto A Schuepbach; Frank Ruschitzka; Holger Moch Journal: Lancet Date: 2020-04-21 Impact factor: 79.321
Authors: Yumiko Imai; Keiji Kuba; Shuan Rao; Yi Huan; Feng Guo; Bin Guan; Peng Yang; Renu Sarao; Teiji Wada; Howard Leong-Poi; Michael A Crackower; Akiyoshi Fukamizu; Chi-Chung Hui; Lutz Hein; Stefan Uhlig; Arthur S Slutsky; Chengyu Jiang; Josef M Penninger Journal: Nature Date: 2005-07-07 Impact factor: 49.962
Authors: Priyank Khandelwal; Fawaz Al-Mufti; Ambooj Tiwari; Amit Singla; Adam A Dmytriw; Mariangela Piano; Luca Quilici; Guglielmo Pero; Leonardo Renieri; Nicola Limbucci; Mario Martínez-Galdámez; Miguel Schüller-Arteaga; Jorge Galván; Juan Francisco Arenillas-Lara; Zafar Hashim; Sanjeev Nayak; Keith Desousa; Hai Sun; Pankaj K Agarwalla; Anil Nanda; J Sudipta Roychowdhury; Emad Nourollahzadeh; Tannavi Prakash; Chirag D Gandhi; Andrew R Xavier; J Diego Lozano; Gaurav Gupta; Dileep R Yavagal Journal: Neurosurgery Date: 2021-06-15 Impact factor: 4.654