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