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The pandemic and neurointervention
Mechanical thrombectomy for acute ischemic stroke in COVID-19 patients: multicenter experience in 111 cases
  1. Hanna Styczen1,
  2. Volker Maus2,
  3. Lukas Goertz3,
  4. Martin Köhrmann4,
  5. Christoph Kleinschnitz4,
  6. Sebastian Fischer2,
  7. Markus Möhlenbruch5,
  8. Iris Mühlen6,
  9. Bernd Kallmünzer7,
  10. Franziska Dorn8,
  11. Asadeh Lakghomi8,
  12. Matthias Gawlitza9,
  13. Daniel Kaiser9,
  14. Joachim Klisch10,
  15. Donald Lobsien10,
  16. Stefan Rohde11,
  17. Gisa Ellrichmann12,
  18. Daniel Behme13,
  19. Maximilian Thormann14,
  20. Fabian Flottmann15,
  21. Laurens Winkelmeier15,
  22. Elke R Gizewski16,
  23. Lukas Mayer-Suess17,
  24. Tobias Boeckh-Behrens18,
  25. Isabelle Riederer18,
  26. Randolf Klingebiel19,
  27. Björn Berger19,
  28. Martin Schlunz-Hendann20,
  29. Dominik Grieb20,
  30. Ali Khanafer21,
  31. Richard du Mesnil de Rochemont22,
  32. Christophe Arendt22,
  33. Jens Altenbernd23,
  34. Jan-Ulrich Schlump24,
  35. Adrian Ringelstein25,
  36. Vivian Jean Marcel Sanio25,
  37. Christian Loehr26,
  38. Agnes Maria Dahlke26,
  39. Carolin Brockmann27,
  40. Sebastian Reder27,
  41. Ulrich Sure28,
  42. Yan Li1,
  43. Ruben Mühl-Benninghaus29,
  44. Thomas Rodt29,
  45. Kai Kallenberg30,
  46. Alexandru Durutya30,
  47. Mohamed Elsharkawy31,
  48. Paul Stracke31,
  49. Mathias Gerhard Schumann32,
  50. Alexander Bock32,
  51. Omid Nikoubashman33,
  52. Martin Wiesmann33,
  53. Hans Henkes21,
  54. Pascal J Mosimann34,
  55. René Chapot34,
  56. Michael Forsting1,
  57. Cornelius Deuschl1
  1. 1 Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
  2. 2 Department of Radiology, Neuroradiology and Nuclear Medicine, University Medical Center Langendreer, Bochum, Germany
  3. 3 Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
  4. 4 Department of Neurology and Center for Translational Neurosciences and Behavioral Sciences (CTNBS), University Hospital Essen, Essen, Germany
  5. 5 Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
  6. 6 Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
  7. 7 Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
  8. 8 Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
  9. 9 Institute and Policlinic of Neuroradiology, Universitatsklinikum Carl Gustav Carus, Dresden, Sachsen, Germany
  10. 10 Department of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, Erfurt, Germany
  11. 11 Department of Radiology and Neuroradiology, Klinikum Dortmund gGmbH, Dortmund, Germany
  12. 12 Department of Neurology, Klinikum Dortmund gGmbH, Dortmund, Germany
  13. 13 Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
  14. 14 Department of Radiology, University Hospital Magdeburg, Magdeburg, Germany
  15. 15 Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  16. 16 Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
  17. 17 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
  18. 18 Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
  19. 19 Department of Diagnostic and Interventional Neuroradiology, University Hospital OWL (Campus Bethel), Bielefeld, Germany
  20. 20 Department of Radiology and Neuroradiology, Klinikum Duisburg - Sana Kliniken, Duisburg, Germany
  21. 21 Clinic for Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
  22. 22 Institute of Neuroradiology, University Hospital Frankfurt and Goethe University, Frankfurt am Main, Germany
  23. 23 Department of Radiology and Neuroradiology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
  24. 24 Department of Neuropediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
  25. 25 Department of Radiology and Neuroradiology, Kliniken Maria Hilf, Moenchengladbach, Germany
  26. 26 Department of Radiology and Neuroradiology, Klinikum Vest, Recklinghausen, Germany
  27. 27 Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
  28. 28 Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany
  29. 29 Department of Radiology, Klinikum Lueneburg, Lueneburg, Germany
  30. 30 Department of Neuroradiology, Klinikum Fulda, Fulda, Germany
  31. 31 Clinic for Radiology, University Hospital Muenster, Muenster, Germany
  32. 32 Department of Neuroradiology, Vivantes Klinikum Neukoelln, Berlin, Germany
  33. 33 Department of Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Aachen, Germany
  34. 34 Department of Neuroradiology, Alfried Krupp Hospital Ruttenscheid, Essen, Germany
  1. Correspondence to Dr Hanna Styczen, Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany; Hanna.Styczen{at}uk-essen.de

Abstract

Background Data on the frequency and outcome of mechanical thrombectomy (MT) for large vessel occlusion (LVO) in patients with COVID-19 is limited. Addressing this subject, we report our multicenter experience.

Methods A retrospective cohort study was performed of consecutive acute stroke patients with COVID-19 infection treated with MT at 26 tertiary care centers between January 2020 and November 2021. Baseline demographics, angiographic outcome and clinical outcome evaluated by the modified Rankin Scale (mRS) at discharge and 90 days were noted.

Results We identified 111 out of 11 365 (1%) patients with acute or subsided COVID-19 infection who underwent MT due to LVO. Cardioembolic events were the most common etiology for LVO (38.7%). Median baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score were 16 (IQR 11.5–20) and 9 (IQR 7–10), respectively. Successful reperfusion (mTICI ≥2b) was achieved in 97/111 (87.4%) patients and 46/111 (41.4%) patients were reperfused completely. The procedure-related complication rate was 12.6% (14/111). Functional independence was achieved in 20/108 (18.5%) patients at discharge and 14/66 (21.2%) at 90 days follow-up. The in-hospital mortality rate was 30.6% (33/108). In the subgroup analysis, patients with severe acute COVID-19 infection requiring intubation had a mortality rate twice as high as patients with mild or moderate acute COVID-19 infection. Acute respiratory failure requiring ventilation and time interval from symptom onset to groin puncture were independent predictors for an unfavorable outcome in a logistic regression analysis.

Conclusion Our study showed a poor clinical outcome and high mortality, especially in patients with severe acute COVID-19 infection undergoing MT due to LVO.

  • COVID-19
  • Infection
  • Stroke
  • Thrombectomy

Data availability statement

Data are available upon reasonable request. Not applicable.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/neurintsurg-2022-018723

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    Data availability statement

    Data are available upon reasonable request. Not applicable.

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    Footnotes

    • Contributors Guarantor: HS; Conception and design: CD, HS. Acquisition of data: HS, VM, MM, IM, FD, DK, DL, SR, MT, FF, ERG, TB-B, RK, MS-H, AK, RdMdR, JA, AR, AMD, CB, RM-B, KK, PS, AB, ON, PJM. Analysis and interpretation of data: VM, LG, MK, CK, SF, BK, AL, MG, JK, GE, DB, LW, LM-S, IR, BB, DG, CA, J-US, VJMS, CL, SR, US, YL, TR, AD, ME, MGS, MW, HH, RC, MF, CD, HS. Drafting the article: HS, LG. All authors have read and approved the manuscript. HS is the guarantor of this study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MM: Grants or contracts from Balt, Medtronic, MircroVention and Stryker. FD: Consultant for Balt, Cerus Endovascular, Phenox and Cerenovus, honoraria for lectures from Cerenovus, Acandis and Asahi, support for attending meetings from MicroVention, Acandis and Cerus Endovascular, advisory board member for Cerenovus/Johnson & Johnson, associate editor for Journal of NeuroInterventional Surgery. MG: Grants or contracts from Else Kröner Fresenius Stiftung, payment of honoraria for lectures from Phenox, proctoring contract with MircroVention, participation on clinical event committee from MicroVention, chair of ESMINT Examination Committee, received stents from Phenox for research purposes. DK: Grants or contracts from Else Kröner Fresenius Center of Digital Health and Joachim Herz Foundation, spokesman of the “Junge Neuroradiologie” in the German Society of Neuroradiology. CL: Consulting fees, payment of honoraria for lectures and support for attending meetings from Phenox, Penumbra and Acandis. MW: Grants from ab medica, Acandis, Bracco Imaging, Cerenovus, Kaneka Pharmaceuticals, Medtronic, Mentice AB, Microvention, Phenox, Siemens Healthcare and Stryker Neurovascular; Consulting fees from Stryker Healthcare; Payment honoraria for lectures from Stryker Neurovascular. The other authors declare no specific conflict of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.