RT Journal Article
SR Electronic
T1 E-145 Mortality following mechanical thrombectomy for ischemic stroke in patients with COVID-19
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP A163
OP A163
DO 10.1136/jnis-2023-SNIS.245
VO 15
IS Suppl 1
A1 Dallas, J
A1 Wenger, T
A1 Liu, K
A1 Ding, L
A1 Hopkins, B
A1 Attenello, F
A1 Mack, W
YR 2023
UL http://jnis.bmj.com/content/15/Suppl_1/A163.2.abstract
AB 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.