TY - JOUR T1 - International experience of mechanical thrombectomy during the COVID-19 pandemic: insights from STAR and ENRG JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 1039 LP - 1044 DO - 10.1136/neurintsurg-2020-016671 VL - 12 IS - 11 AU - Sami Al Kasab AU - Eyad Almallouhi AU - Ali Alawieh AU - Michael R Levitt AU - Pascal Jabbour AU - Ahmad Sweid AU - Robert M Starke AU - Vasu Saini AU - Stacey Q Wolfe AU - Kyle M Fargen AU - Adam S Arthur AU - Nitin Goyal AU - Abhi Pandhi AU - Isabel Fragata AU - Ilko Maier AU - Charles Matouk AU - Jonathan A Grossberg AU - Brian M Howard AU - Peter Kan AU - Muhammad Hafeez AU - Clemens M Schirmer AU - R Webster Crowley AU - Krishna C Joshi AU - Stavropoula I Tjoumakaris AU - Shakeel Chowdry AU - William Ares AU - Christopher Ogilvy AU - Santiago Gomez-Paz AU - Ansaar T. Rai AU - Maxim Mokin AU - Waldo Guerrero AU - Min S Park AU - Justin R Mascitelli AU - Albert Yoo AU - Richard Williamson AU - Andrew Walker Grande AU - Roberto Javier Crosa AU - Sharon Webb AU - Marios N Psychogios AU - Andrew F Ducruet AU - Christine A Holmstedt AU - Andrew J Ringer AU - Alejandro M Spiotta A2 - , Y1 - 2020/11/01 UR - http://jnis.bmj.com/content/12/11/1039.abstract N2 - 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. ER -