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E-145 Mortality following mechanical thrombectomy for ischemic stroke in patients with COVID-19
  1. J Dallas1,
  2. T Wenger2,
  3. K Liu2,
  4. L Ding3,
  5. B Hopkins1,
  6. F Attenello1,
  7. W Mack1
  1. 1Department of Neurological Surgery, University of Southern California, Los Angeles, CA, USA
  2. 2Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
  3. 3Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA


Introduction Multiple prior studies have established a relationship between COVID-19 and ischemic stroke, which is likely multifactorial in nature. That said, while COVID-19 likely has a direct impact on the pathophysiology of stroke, it has also been shown to influence the acute treatment response to stroke, with increased time-to-thrombectomy and decreased overall thrombectomy rates. Using large-scale, recently released national data, this study assessed the effect of COVID-19 on patient outcomes following mechanical thrombectomy.

Methods Patients in this study were identified from the 2020 National Inpatient Sample. All patients with arterial strokes undergoing mechanical thrombectomy were identified using ICD-10 coding criteria; those with venous infarctions or other causes of stroke were excluded. Patients were further stratified by COVID-19 diagnosis (positive vs. negative). Other covariates, including patient/hospital demographics, disease severity, and comorbidities (assessed via both APR-DRG risk of mortality and Elixhauser Comorbidity Index) were collected. Multivariable analysis was used to determine the independent effect of COVID-19 on both in-hospital mortality and unfavorable discharge.

Results 5078 patients were identified in this study; 166 (3.3%) were found to be COVID-19 positive during their hospitalization. COVID-19 patients had a significantly higher mortality rate (30.1% vs. 12.4%, p < 0.001). Patients with COVID-19 were more likely to be younger in age (p<0.001) and had higher APR-DRG risk of morality/illness severity. There was no significant difference in Elixhauser Comorbidity Index (ECI) when stratified by COVID-19 status.

When controlling for patient/hospital characteristics, APR-DRG disease severity, and ECI, COVID-19 was an independent predictor of increased mortality following mechanical thrombectomy (OR 1.13, p = 0.002). COVID-19 was not significantly related to discharge disposition (p = 0.480). Older age and increased APR-DRG disease severity were also correlated with increase morality.

Conclusion Overall, this study indicates that COVID-19 is a predictor of mortality among mechanical thrombectomy. This finding is likely multifactorial but may be related to multisystem inflammation, hypercoagulability, and re-occlusion seen in COVID-19 patients. Treatment-related factors, such as delays in care, may also play a role. Additional research would be needed to further delineate these findings.

Disclosures J. Dallas: None. T. Wenger: None. K. Liu: None. L. Ding: None. B. Hopkins: None. F. Attenello: None. W. Mack: None.

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