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Alarming downtrend in mechanical thrombectomy rates in African American patients during the COVID-19 pandemic-Insights from STAR
  1. Sami Al Kasab1,2 STAR collaborators,
  2. Eyad Almallouhi1,2,
  3. Ali Alawieh3,4,
  4. Pascal Jabbour5,
  5. Ahmad Sweid5,
  6. Robert M Starke6,
  7. Vasu Saini6,
  8. Stacey Q Wolfe7,
  9. Kyle M Fargen8,
  10. Adam S Arthur9,10,
  11. Nitin Goyal10,
  12. Abhi Pandhi11,
  13. Ilko Maier12,
  14. Jonathan A Grossberg13,
  15. Brian M Howard14,15,
  16. Stavropoula I Tjoumakaris5,
  17. Ansaar Rai16,
  18. Min S Park17,
  19. Justin R Mascitelli18,
  20. Marios N Psychogios19,
  21. Alejandro M Spiotta1
  1. 1 Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
  2. 2 Neurology, Medical University of South Carolina, Charleston, SC, USA
  3. 3 Neurosurgery, Emory University, Atlanta, GA, USA
  4. 4 Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA
  5. 5 Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
  6. 6 Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
  7. 7 Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
  8. 8 Neurosurgery, Wake Forest University, Winston-Salem, NC, USA
  9. 9 Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  10. 10 Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  11. 11 Neurology, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
  12. 12 Neurology, University Medicine Goettingen, Goettingen, NS, Germany
  13. 13 Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
  14. 14 Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
  15. 15 Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
  16. 16 Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
  17. 17 Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  18. 18 Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
  19. 19 Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
  1. Correspondence to Dr Sami Al Kasab, Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA; alkasab{at}


Background The coronavirus disease (COVID-19) pandemic has affected stroke care globally. In this study, we aim to evaluate the impact of the current pandemic on racial disparities among stroke patients receiving mechanical thrombectomy (MT).

Methods We used the prospectively collected data in the Stroke Thrombectomy and Aneurysm Registry from 12 thrombectomy-capable stroke centers in the US and Europe. We included acute stroke patients who underwent MT between January 2017 and May 2020. We compared baseline features, vascular risk factors, location of occlusion, procedural metrics, complications, and discharge outcomes between patients presenting before (before February 2020) and those who presented during the pandemic (February to May 2020).

Results We identified 2083 stroke patients: of those 235 (11.3%) underwent MT during the COVID-19 pandemic. Compared with pre-pandemic, stroke patients who received MT during the pandemic had longer procedure duration (44 vs 38 min, P=0.006), longer length of hospitalization (6 vs 4 days, P<0.001), and higher in-hospital mortality (18.7% vs 11%, P<0.001). Importantly, there was a lower number of African American patients undergoing MT during the COVID-19 pandemic (609 (32.9%) vs 56 (23.8%); P=0.004).

Conclusion The COVID-19 pandemic has affected the care process for stroke patients receiving MT globally. There is a significant decline in the number of African American patients receiving MT, which mandates further investigation.

  • thrombectomy
  • stroke

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  • SAK and EA are joint first authors.

  • Twitter @samialkasab, @PascalJabbourMD, @AhmadSweidMD, @Starke_neurosurgery, @AdamArthurMD, @abhipandhi, @BrianHoward_MD, @alex_spiotta

  • Collaborators STAR collaborators: Dileep R Yavagal, MD; Eric C Peterson, MD; Alex Brehm, MD; Patrick A Brown, MD; M. Reid Gooch, MD; Nabeel Herial, MD; Dr. med. Jan Liman; Daniel Alan Hoit MD MPH; Violiza Inoa-Acosta MD; Christopher Nickele MD; Lucas Elijovich MD; Michael Cawley, MD; Gustavo Pradilla, 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.

  • Competing interests PJ: consultant-Medtronics, Microvention. RMS: consulting and teaching agreements with Penumbra, Abbott, Medtronic, InNeuroCo, and Cerenovus. ASA: consultant–Balt, Johnson and Johnson, Leica, Medtronic, Microvention, Penumbra, Scientia, Siemens, and Stryker; research support–Cerenovus, Microvention, Penumbra, and Siemens; and shareholder–Bendit, Cerebrotech, Endostream, Magneto, Marblehead, Neurogami, Serenity, Synchron, Triad Medical, Vascular Simulations. AR: consulting agreement with Stryker, Cerenovus, and Microvention. MNP: travel grants/honoraria–Phenox, Stryker, Siemens. AMS: consultant–Penumbra, Microvention, and Pulsar Vascular; travel grants/honoraria–Penumbra, Pulsar Vascular, Microvention, Stryker.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request. Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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