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.
Original language | English (US) |
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Pages (from-to) | 725-733 |
Number of pages | 9 |
Journal | Neurosurgery |
Volume | 90 |
Issue number | 6 |
DOIs | |
State | Published - Jun 1 2022 |
Externally published | Yes |
Keywords
- COVID-19
- Central nervous system
- Cerebrovascular disease
- Hypercoagulable
- SARS-CoV-2
ASJC Scopus subject areas
- Clinical Neurology
- Surgery