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

Styczen H, Maus V, Goertz L, Koehrmann M, Kleinschnitz C, Fischer S, Moehlenbruch M, Mühlen I, Kallmünzer B, Dorn F, Lakghomi A, Gawlitza M, Kaiser D, Klisch J, Lobsien D, Rohde S, Ellrichmann G, Behme D, Thormann M, Flottmann F, Winkelmeier L, Gizewski ER, Mayer-Suess L, Boeckh-Behrens T, Riederer I, Klingebiel R, Berger B, Schlunz-Hendann M, Grieb D, Khanafer A, De Rochemont RDM, Arendt C, Altenbernd J, Schlump JU, Ringelstein A, Sanio VJM, Loehr C, Dahlke AM, Brockmann C, Reder S, Sure U, Li Y, Muehl-Benninghaus R, Rodt T, Kallenberg K, Durutya A, Elsharkawy M, Stracke P, Schumann MG, Bock A, Nikoubashman O, Wiesmann M, Henkes H, Mosimann PJ, Chapot R, Forsting M, Deuschl C (2022)

Publication Type: Journal article

Publication year: 2022

Journal

DOI: 10.1136/neurintsurg-2022-018723

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 with CRIS profile

Involved external institutions

Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Klinikum Stuttgart Germany (DE) Kliniken Maria Hilf GmbH Germany (DE) Klinikum Vest Germany (DE) Helios Klinikum Erfurt Germany (DE) Klinikum Dortmund Germany (DE) Universitätsklinikum Magdeburg A.ö.R. Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Medizinische Universität Innsbruck Austria (AT) Technische Universität München (TUM) Germany (DE) Evangelisches Klinikum Bethel Germany (DE) Sana Kliniken Duisburg Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Gemeinschaftskrankenhaus Herdecke Germany (DE) Universitätsklinikum Essen Germany (DE) Universitätsklinikum Knappschaftskrankenhaus Bochum Germany (DE) Universitätsklinikum Köln Germany (DE) Ruprecht-Karls-Universität Heidelberg Germany (DE) Universitätsklinikum Bonn Germany (DE) Universitätsmedizin der Johannes Gutenberg-Universität Mainz Germany (DE) Städtisches Klinikum Lüneburg Germany (DE) Klinikum Fulda Germany (DE) Universitätsklinikum Münster Germany (DE) Vivantes - Netzwerk für Gesundheit GmbH Germany (DE) Universitätsklinikum Aachen (UKA) Germany (DE) Alfried Krupp Krankenhaus Germany (DE)

How to cite

APA:

Styczen, H., Maus, V., Goertz, L., Koehrmann, M., Kleinschnitz, C., Fischer, S.,... Deuschl, C. (2022). Mechanical thrombectomy for acute ischemic stroke in COVID-19 patients: multicenter experience in 111 cases. Journal of Neurointerventional Surgery. https://doi.org/10.1136/neurintsurg-2022-018723

MLA:

Styczen, Hanna, et al. "Mechanical thrombectomy for acute ischemic stroke in COVID-19 patients: multicenter experience in 111 cases." Journal of Neurointerventional Surgery (2022).

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