RT Journal Article SR Electronic 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 FD BMJ Publishing Group Ltd. SP 1039 OP 1044 DO 10.1136/neurintsurg-2020-016671 VO 12 IS 11 A1 Sami Al Kasab A1 Eyad Almallouhi A1 Ali Alawieh A1 Michael R Levitt A1 Pascal Jabbour A1 Ahmad Sweid A1 Robert M Starke A1 Vasu Saini A1 Stacey Q Wolfe A1 Kyle M Fargen A1 Adam S Arthur A1 Nitin Goyal A1 Abhi Pandhi A1 Isabel Fragata A1 Ilko Maier A1 Charles Matouk A1 Jonathan A Grossberg A1 Brian M Howard A1 Peter Kan A1 Muhammad Hafeez A1 Clemens M Schirmer A1 R Webster Crowley A1 Krishna C Joshi A1 Stavropoula I Tjoumakaris A1 Shakeel Chowdry A1 William Ares A1 Christopher Ogilvy A1 Santiago Gomez-Paz A1 Ansaar T. Rai A1 Maxim Mokin A1 Waldo Guerrero A1 Min S Park A1 Justin R Mascitelli A1 Albert Yoo A1 Richard Williamson A1 Andrew Walker Grande A1 Roberto Javier Crosa A1 Sharon Webb A1 Marios N Psychogios A1 Andrew F Ducruet A1 Christine A Holmstedt A1 Andrew J Ringer A1 Alejandro M Spiotta A1 , YR 2020 UL http://jnis.bmj.com/content/12/11/1039.abstract AB 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.