Background In response to the COVID-19 pandemic, many centers altered stroke triage protocols for the protection of their providers. However, the effect of workflow changes on stroke patients receiving mechanical thrombectomy (MT) has not been systematically studied.
Methods A prospective international study was launched at the initiation of the COVID-19 pandemic. All included centers participated in the Stroke Thrombectomy and Aneurysm Registry (STAR) and Endovascular Neurosurgery Research Group (ENRG). Data was collected during the peak months of the COVID-19 surge at each site. Collected data included patient and disease characteristics. A generalized linear model with logit link function was used to estimate the effect of general anesthesia (GA) on in-hospital mortality and discharge outcome controlling for confounders.
Results 458 patients and 28 centers were included from North America, South America, and Europe. Five centers were in high-COVID burden counties (HCC) in which 9/104 (8.7%) of patients were positive for COVID-19 compared with 4/354 (1.1%) in low-COVID burden counties (LCC) (P<0.001). 241 patients underwent pre-procedure GA. Compared with patients treated awake, GA patients had longer door to reperfusion time (138 vs 100 min, P=<0.001). On multivariate analysis, GA was associated with higher probability of in-hospital mortality (RR 1.871, P=0.029) and lower probability of functional independence at discharge (RR 0.53, P=0.015).
Conclusion We observed a low rate of COVID-19 infection among stroke patients undergoing MT in LCC. Overall, more than half of the patients underwent intubation prior to MT, leading to prolonged door to reperfusion time, higher in-hospital mortality, and lower likelihood of functional independence at discharge.
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SAK and EA are joint first authors.
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Collaborators Dileep R Yavagal MD, Eric C Peterson MD, Daniel Raper MBBS, Patrick A Brown MD, M. Reid Gooch MD, Nabeel Herial MD, Ajith Thomas MD, Justin Moore MD, Felipe Albuquerque MD, Louis J. Kim MD, Melanie Walker MD, Michael Chen MD, Stephan Munich MD, Daniel Alan Hoit MD MPH, Violiza Inoa-Acosta MD, Christopher Nickele MD, Lucas Elijovich MD, Fernanda Rodriguez-Erazú PD Dr. med. Jan Liman, Michael Cawley, MD, Gustavo Pradilla MD, Brian Walcot, MD, Zeguang Re, MD PhD, Ryan Hebert MD, João Rei, MD, Jaime Pamplon, Rui Carvalho MD, Mariana Baptist, MD, Ana Nunes MD, Russell Cerejo MD, Ashis Tayal MD, Parita Bhuv, MD, Paul Hansen MD, Norman Ajiboye MD, Alex Brehm, MD
Contributors All authors have: provided a substantial contribution to the conception and design of the studies and/or the acquisition and/or the analysis of the data and/or the interpretation of the data. They have drafted the work or revised it for significant intellectual content and approved the final version of the manuscript. They agree to be accountable for all aspects of the work, including its accuracy and integrity.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
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Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Additional data from this project can be acquired by contacting the corresponding author.