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

Styczen, Hanna; Maus, Volker; Goertz, Lukas; Köhrmann, Martin; Kleinschnitz, Christoph; Fischer, Sebastian; Möhlenbruch, Markus; Muehlen, Iris; Kallmünzer, Bernd; Dorn, Franziska; Lakghomi, Asadeh; Gawlitza, Matthias; Kaiser, Daniel; Klisch, Joachim; Lobsien, Donald; Rohde, Stefan; Ellrichmann, Gisa; Behme, Daniel; Thormann, Maximilian; Flottmann, Fabian; Winkelmeier, Laurens; Gizewski, Elke R.; Mayer, Lukas; Boeckh‐Behrens, Tobias; Riederer, Isabelle; Klingebiel, Randolf; Berger, Björn; Schlunz-Hendann, Martin; Grieb, Dominik; Khanafer, Ali; Rochemont, Richard du Mesnil de; Arendt, Christophe; Altenbernd, Jens; Schlump, Jan-Ulrich; Ringelstein, Adrian; Sanio, Vivian; Loehr, Christian; Dahlke, Agnes Maria; Brockmann, Carolin; Reder, Sebastian; Sure, Ulrich; Li, Yan; Mühl-Benninghaus, Ruben; Rodt, Thomas; Kallenberg, Kai; Durutya, Alexandru; Elsharkawy, Mohamed; Stracke, Paul; Schumann, Mathias Gerhard; Bock, Alexander; Nikoubashman, Omid; Wiesmann, Martin; Henkes, Hans; Mosimann, Pascal J.; Chapot, René; Forsting, Michael; Deuschl, Cornelius

doi:10.1136/neurintsurg-2022-018723

Cited by 6 publications

(3 citation statements)

References 30 publications

(55 reference statements)

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“…A multicentre study collected data on 93 COVID-19 LVO patients who eventually underwent MT, and noted a 29% 30-day mortality, which was concurrent with higher inflammatory serum biomarker levels (aspartate, LDH) [ 117 ]. Poor prognosis, with a median NIHSS = 13 at discharge, and high rates of mortality (30.6% by discharge) were also consistently detected in another cohort of 111 LVO patients [ 118 ]. Treatment in the multicentre study by Abdalkader et al and the observational study by Hameed et al most commonly consisted of systemic anticoagulation administration of low-molecular-weight heparin (LMWH) or unfractionated heparin, for CVST.…”

Section: Management Of Patients With Cerebrovascular Sequelae During ...mentioning

confidence: 88%

Cerebrovascular Manifestations of SARS-CoV-2: A Comprehensive Review

Stefanou¹,

Karvelas

Bennett

et al. 2023

Curr Treat Options Neurol

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Purpose of review The risks of cerebrovascular manifestations due to SARS-CoV-2 infection are significantly increased within the first 6 months of the infection. Our work aims to give an update on current clinical aspects of diagnosis and treatment of cerebrovascular manifestations during acute and long-term SARS-CoV-2 infection. Recent findings The incidence of acute ischemic stroke and haemorrhagic stroke during acute SARS-CoV-2 patients is estimated at 0.9 to 4.6% and 0.5–0.9%, respectively, and were associated with increased mortality. The majority presented with hemiparesis, dysarthria, sensory deficits, and a NIHSS score within 5–15. In addition, beyond the first 30 days of infection people with COVID-19 exhibited increased risk of stroke. During acute phase, age, hypertension, diabetes, and medical history of vascular disease were increased in patients with COVID-19 with new onset of cerebrovascular manifestations, while during long-COVID-19, the risk of cerebrovascular manifestations were found increased regardless of these factors. The management of patients with large-vessel ischemic stroke fulfilling the intravenous thrombolysis criteria are successfully treated according to the guidelines, while hyperosmolar therapy is typically administered in 4- to 6-h intervals. In addition, prophylaxis of anticoagulation therapy is associated with a better prognosis and low mortality during acute and post hospital discharge of patients with COVID-19. Summary In this work, we provide a comprehensive review of the current literature on acute and post-acute COVID-19 cerebrovascular sequelae, symptomatology, and its pathophysiology mechanisms. Moreover, we discuss therapeutic strategies for these patients during acute and long-term care and point populations at risk. Our findings suggest that older patients with risk factors such as hypertension, diabetes, and medical history of vascular disease are more likely to develop cerebrovascular complications.

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Section: Management Of Patients With Cerebrovascular Sequelae During ...mentioning

confidence: 88%

Cerebrovascular Manifestations of SARS-CoV-2: A Comprehensive Review

Stefanou¹,

Karvelas

Bennett

et al. 2023

Curr Treat Options Neurol

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“…http://jnis.bmj.com/ with COVID-19 and may explain why this stroke type is more common. 22 However, it is not well understood why patients with COVID-19 have more strokes, and this is a current area of active study. 23 In patients undergoing MT for LVO, the observed inpatient mortality rate was 22.4%, which appears comparable to the rates in the available literature.…”

Section: Relation To Other Studiesmentioning

confidence: 99%

Outcomes in patients with large vessel occlusion strokes undergoing mechanical thrombectomy with concurrent COVID-19: a nationwide retrospective analysis

Ramsay

Fountain

Elarjani

et al. 2023

J NeuroIntervent Surg

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BackgroundPreliminary studies show that patients with large vessel occlusion (LVO) acute ischemic strokes have worse outcomes with concurrent COVID-19 infection. We investigated the outcomes for patients with LVO strokes undergoing mechanical thrombectomy (MT) with concurrent COVID-19 infection.MethodsThe National Inpatient Database (NIS) was used for our analysis. Patients in the year 2020 with an ICD-10 diagnosis code for acute ischemic stroke and procedural code for MT were included with and without COVID-19. Odds ratios (OR) were calculated using a logistic regression model with age, sex, stroke location, Elixhauser comorbidity score, and other patient variables deemed clinically relevant as covariates.ResultsPatients in the COVID-19 group were younger (64.3±14.4 vs 69.4±14.5 years, P<0.001), had a higher rate of inpatient mortality (22.4% vs 10.1%, P<0.001), and a longer length of stay (10 vs 6 days, P<0.001). Patients with COVID-19 had higher odds of death (OR 2.78, 95% CI 2.11 to 3.65) and lower odds of a routine discharge (OR 0.65, 95% CI 0.48 to 0.89). There was no difference in the odds of subsequent stroke and cerebral hemorrhage, but patients with COVID-19 had statistically significantly higher odds of respiratory failure, pulmonary embolism, deep vein thrombosis, myocardial infarction, acute kidney injury, and sepsis.ConclusionsPatients with LVOs undergoing MT within the 2020 NIS database had worse outcomes when co-diagnosed with COVID-19, likely due to non-neurological manifestations of COVID-19.

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“… 1 , 2 In addition, recent studies of large series of patients with COVID‐19 infection have reported a devastating clinical outcome of patients with AIS attributable to large‐vessel occlusion treated with mechanical thrombectomy (MT), with mortality rates up to 31%. 3 , 4 …”

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confidence: 99%

Impact of Vaccination Status on Outcome of Patients With COVID‐19 and Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

Deuschl,

Goertz,

Kabbasch

et al. 2024

JAHA

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Background Data on impact of COVID‐19 vaccination and outcomes of patients with COVID‐19 and acute ischemic stroke undergoing mechanical thrombectomy are scarce. Addressing this subject, we report our multicenter experience. Methods and Results This was a retrospective analysis of patients with COVID‐19 and known vaccination status treated with mechanical thrombectomy for acute ischemic stroke at 20 tertiary care centers between January 2020 and January 2023. Baseline demographics, angiographic outcome, and clinical outcome evaluated by the modified Rankin Scale score at discharge were noted. A multivariate analysis was conducted to test whether these variables were associated with an unfavorable outcome, defined as modified Rankin Scale score >3. A total of 137 patients with acute ischemic stroke (48 vaccinated and 89 unvaccinated) with acute or subsided COVID‐19 infection who underwent mechanical thrombectomy attributable to vessel occlusion were included in the study. Angiographic outcomes between vaccinated and unvaccinated patients were similar (modified Thrombolysis in Cerebral Infarction ≥2b: 85.4% in vaccinated patients versus 86.5% in unvaccinated patients; P =0.859). The rate of functional independence (modified Rankin Scale score, ≤2) was 23.3% in the vaccinated group and 20.9% in the unvaccinated group ( P =0.763). The mortality rate was 30% in both groups. In the multivariable analysis, vaccination status was not a significant predictor for an unfavorable outcome ( P =0.957). However, acute COVID‐19 infection remained significant (odds ratio, 1.197 [95% CI, 1.007–1.417]; P =0.041). Conclusions Our study demonstrated no impact of COVID‐19 vaccination on angiographic or clinical outcome of COVID‐19–positive patients with acute ischemic stroke undergoing mechanical thrombectomy, whereas worsening attributable to COVID‐19 was confirmed.

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

Cited by 6 publications

References 30 publications

Cerebrovascular Manifestations of SARS-CoV-2: A Comprehensive Review

Cerebrovascular Manifestations of SARS-CoV-2: A Comprehensive Review

Outcomes in patients with large vessel occlusion strokes undergoing mechanical thrombectomy with concurrent COVID-19: a nationwide retrospective analysis

Impact of Vaccination Status on Outcome of Patients With COVID‐19 and Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

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