Background COVID-19 is now well documented as a contributor to stroke. In single center and multicenter series for mechanical thrombectomy, there are conflicting results about outcomes. In general, it appears that mechanical thrombectomy in COVID-19 has a significantly higher mortality. However, most data is from 2020-2021, and very little is available on 90day outcomes. We present data on COVID positive mechanical thrombectomy patients from 2021-2023 to evaluate how outcomes evolved as the pandemic progressed.

Methods We performed a retrospective review of mechanical thrombectomies from 12/2020 to 3/2023. COVID positive and recent COVID recovered were included. Demographic, procedural, and 90day functional outcomes were evaluated.

Results There were 300 patients treated with mechanical thrombectomy for acute ischemic stroke at our center between 12/2020 and 3/2023. 18 patients were identified as COVID positive at the time of mechanical thrombectomy. There was 1 patient who underwent sequential bilateral thrombectomies. 42% were cardioembolic in origin, and 26% were likely hypercoagulable(TOAST 4). 14/18(78%) had TICI 2b/3 revascularization. Of the 17 patients whose outcomes are available, 90d mRS 0-2 was 29%, while mRS 6 was 53%. Several of these patients died in delayed fashion despite being COVID recovered.

Conclusion Late in the pandemic, mortality rates remain very high for patients with COVID-19 undergoing mechanical thrombectomy. This is significant in that later circulating variants appear to cause less severe disease.

Disclosures C. Houk: None. N. Ellens: None. G. Kohli: None. D. Schartz: None. D. Proper: None. T. Bhalla: None. M. Bender: None. T. Mattingly: None.