International experience of mechanical thrombectomy during the COVID-19 pandemic: insights from STAR and ENRG

Sami Al Kasab, Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Eyad Almallouhi, Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
Ali Alawieh, Neurosurgery, Emory University, Atlanta, Georgia, USA.
Michael R. Levitt, Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
Pascal Jabbour, Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Ahmad Sweid, Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Robert M. Starke, Neurological Surgery, University of Miami Miller School of Medicine, Miami Beach, Florida, USA.
Vasu Saini, University of Miami Miller School of Medicine, Miami, Florida, USA.
Stacey Q. Wolfe, Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
Kyle M. Fargen, Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
Adam S. Arthur, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
Nitin Goyal, Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Abhi Pandhi, Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Isabel Fragata, Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
Ilko Maier, Neurology, University Medicine Goettingen, Goettingen, NS, Germany.
Charles Matouk, Neurosurgery, Yale University, New Haven, Connecticut, USA.
Jonathan A. Grossberg, Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Brian M. Howard, Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Peter Kan, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
Muhammad Hafeez, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
Clemens M. Schirmer, Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA.
R Webster Crowley, Rush University, Chicago, Illinois, USA.
Krishna C. Joshi, Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Stavropoula I. Tjoumakaris, Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Shakeel Chowdry, North Shore University Health System, Evanston, Illinois, USA.
William Ares, Neurosurgery, North Shore University Health System, Evanston, Illinois, USA.
Christopher Ogilvy, Neurosurgery, BIDMC, Boston, Massachusetts, USA.
Santiago Gomez-Paz, Neurosurgery, BIDMC, Boston, Massachusetts, USA.
Ansaar T. Rai, Department of Neurointerventional Radiology, West Virginia University, Morgantown, West Virginia, USA.
Maxim Mokin, Neurosurgery, University of South Florida, Tampa, Florida, USA.
Waldo Guerrero, Neurosurgery, University of South Florida, Tampa, Florida, USA.
Min S. Park, Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.

Document Type

Article

Abstract

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.

Keywords

complication, stroke, thrombectomy

Medical Subject Headings

Aged; Aged, 80 and over; Anesthesia, General; COVID-19; Coronavirus Infections; Endovascular Procedures; Female; Hospital Mortality; Humans; Independent Living; Linear Models; Male; Middle Aged; Pandemics; Pneumonia, Viral; Prospective Studies; Reperfusion; Stroke (therapy); Thrombectomy (methods, statistics & numerical data); Treatment Outcome; Workflow

Publication Date

11-1-2020

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

Volume

12

Issue

11

First Page

1039

Last Page

1044

PubMed ID

32843359

Digital Object Identifier (DOI)

10.1136/neurintsurg-2020-016671

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