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The Pandemic and Neurointervention
Endovascular thrombectomy in acute ischemic stroke patients with COVID-19: prevalence, demographics, and outcomes
  1. Adam de Havenon1,
  2. Shadi Yaghi2,
  3. Eva A Mistry3,
  4. Alen Delic1,
  5. Samuel Hohmann4,
  6. Ernie Shippey4,
  7. Eric Stulberg1,
  8. David Tirschwell5,
  9. Jennifer A Frontera2,
  10. Nils H Petersen6,
  11. Mohammad Anadani7
  1. 1 Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
  2. 2 Neurology, NYU School of Medicine, Brooklyn, New York, USA
  3. 3 Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  4. 4 Vizient Inc, Irving, Texas, USA
  5. 5 University of Washington, Seattle, Washington, USA
  6. 6 Yale University, New Haven, Connecticut, USA
  7. 7 Washington University School of Medicine in St Louis, St Louis, Missouri, USA
  1. Correspondence to Dr Adam de Havenon, Department of Neurology, University of Utah Health, Salt Lake City, UT 84132, USA; adam.dehavenon{at}hsc.utah.edu

Abstract

Background We aimed to compare the outcome of acute ischemic stroke (AIS) patients who received endovascular thrombectomy (EVT) with confirmed COVID-19 to those without.

Methods We performed a retrospective analysis using the Vizient Clinical Data Base and included hospital discharges from April 1 to July 31 2020 with ICD-10 codes for AIS and EVT. The primary outcome was in-hospital death and the secondary outcome was favorable discharge, defined as discharge home or to acute rehabilitation. We compared patients with laboratory-confirmed COVID-19 to those without. As a sensitivity analysis, we compared COVID-19 AIS patients who did not undergo EVT to those who did, to balance potential adverse events inherent to COVID-19 infection.

Results We identified 3165 AIS patients who received EVT during April to July 2020, in which COVID-19 was confirmed in 104 (3.3%). Comorbid COVID-19 infection was associated with younger age, male sex, diabetes, black race, Hispanic ethnicity, intubation, acute coronary syndrome, acute renal failure, and longer hospital and intensive care unit length of stay. The rate of in-hospital death was 12.4% without COVID-19 vs 29.8% with COVID-19 (P<0.001). In mixed-effects logistic regression that accounted for patient clustering by hospital, comorbid COVID-19 increased the odds of in-hospital death over four-fold (OR 4.48, 95% CI 3.02 to 6.165). Comorbid COVID-19 was also associated with lower odds of a favorable discharge (OR 0.43, 95% CI 0.30 to 0.61). In the sensitivity analysis, comparing AIS patients with COVID-19 who did not undergo EVT (n=2139) to the AIS EVT patients with COVID-19, there was no difference in the rate of in-hospital death (30.6% vs 29.8%, P=0.868), and AIS EVT patients had a higher rate of favorable discharge (32.4% vs 47.1%, P=0.002).

Conclusion In AIS patients treated with EVT, comorbid COVID-19 infection was associated with in-hospital death and a lower odds of favorable discharge compared with patients without COVID-19, but not compared with AIS patients with COVID-19 who did not undergo EVT. AIS EVT patients with COVID-19 were younger, more likely to be male, have systemic complications, and almost twice as likely to be black and over three times as likely to be Hispanic.

  • stroke
  • infection
  • thrombectomy

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/neurintsurg-2020-016777

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Correction notice Since this article was first published online first changes have been made to table 1. The use of 'to' has been changed to the % symbol in both covid columns.

    • Contributors AdH and MA conceived of the study and drafted/edited the manuscript, AD helped with statistical analysis, ESh and SH helped conceive of the study and provided the data, SY, EM, Est, DT, NP, and JS provided critical revisions and feedback.

    • Funding Dr. de Havenon is supported by NIH-NINDS K23NS105924. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    • Competing interests Dr. de Havenon has received investigator-initiated funding from AMAG and Regeneron pharmaceuticals. The remaining authors report no potential conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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