Background and objectives:COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower efficacy of revascularization treatments in patients with acute ischemic stroke. We aimed to evaluate the safety and outcomes of revascularization treatments in patients with acute ischemic stroke and COVID-19.Methods:Retrospective multicenter cohort study of consecutive patients with acute ischemic stroke receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021, tested for SARS-CoV-2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT).Results:Of a total of 15128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT-only, and 9280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted odds ratio [OR] 1.53; 95% CI 1.16–2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20–2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23–1.99), 24-hour (OR 2.47; 95% CI 1.58–3.86) and 3-month mortality (OR 1.88; 95% CI 1.52–2.33).COVID-19 patients also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26–1.60).Discussion:Patients with acute ischemic stroke and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 treated patients. Current available data does not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in COVID-19 patients, or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring and establishing prognosis.

Introduction Efficient and timely recanalisation is an important goal in acute stroke endovascular therapy. Several studies have shown improved recanalisation and clinical outcomes with the Stentriever devices compared to the MERCI device. The goal of this study was to evaluate the role of the balloon guide catheter and recanalisation success in a sub-study of the North American Solitaire Stent-Retriever Acute Stroke Registry (NASA). Methods The investigator-initiated NASA Registry recruited 24 clinical sites in North America to submit demographic, clinical, site-adjudicated angiographic and clinical outcome data on consecutive patients treated with the Solitaire FR device (Covidien). Balloon guide catheter was used at the discretion of the treating physicians. Results There were 354 patients included in this study. Data of BGC use was not reported in 16 patients, leaving 338 patients in this sub-analysis, of which 149 (44%) had placement of the BGC. Mean age was 67.3+15.2 years and median NIHSS was 18. Patients with BGC had more hypertension (82% vs 73%; p=0.05), atrial fibrillation (51% vs 33%; p=0.001) and were more commonly administered tPA (51% vs 39%; p=0.02) compared to patients without BGC. Time from symptom onset to groin puncture and number of passes were similar between the two groups. Procedure time was shorter in patients with BGC (120 vs 161 minutes, p=0.02) and less rescue therapy was used in patients with BGC (20% vs 28.6%, p=0.05). TICI 2b/3, TICI 3 recanalisation was higher in patients with BGC compared to patients without (TICI 2b/3: 75% vs 70%; TICI 3 53% vs 32.5% p>0.001). Distal emboli and emboli in new territory were similar between the two groups. Discharge NIHSS (mean 12 vs 17.5; p=0.002) and good clinical outcome at 3 months were superior in patients with BGC compared to patients without (51.6% vs 35.8%; p=0.02). In multivariate analysis, initial NIHSS, use of general anaesthesia and BGC were independent predictors of good clinical outcome. Conclusion Use of a balloon guide catheter with the Solitaire Stent retriever in acute ischaemic stroke results in superior recanalisation results, faster procedure time, decreased need for rescue therapy, and improved clinical outcome. Disclosures T. Nguyen: 2; C; Penumbra, THERAPY Trial DSMB/ CEC. T. Malisch: None. A. Castonguay: None. R. Gupta: None. C. Sun: None. C. Martin: None. W. Holloway: None. N. Mueller-Kronast: None. I. Linfante: None. G. Dabus: None. F. Marden: None. H. Bozorgchami: None. A. Xavier: None. A. Rai: None. A. Badruddin: None. M. Taqi: None. M. Abraham: None. H. Shaltoni: None. V. Janardhan: None. A. Abou Chebl: None. P. Chen: None. A. Yoo: None. R. Nogueira: None. A. Norbash: None. O. Zaidat: None.

Background: Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in the elderly presents a unique set of challenges and opportunities. Most existing studies include patients up to the age of 90 with stricter criteria of inclusion for patients ≥ 80 years of age. The following study compares the outcomes in octogenarians compared to younger patients in a single center. Methods: We conducted a retrospective chart review of patients who were ≥ 80yo who underwent MT from March 2016 to July 2019. Data on age, recanalization score measured by Thrombolysis in Cerebral Infarction (TICI) score and clinical outcomes were compared to 126 patients < 80 years of age treated during the same time period. Clinical outcomes were classified based on modified Rankin score (mRS) at discharge. Poor outcomes were defined as mRS 4-6. Good recanalization was defined as TICI score 2b or 3. Results: Eighty-three patients with a median age of 86±4.34yo were compared to 126 patients with median age of 63±12.48yo (p<0.0001). Good recanalization was achieved in 74% of patients ≥80yo compared to 84% in patients <80yo (p= 0.06). Poor outcomes were reported in 74.6% of patients ≥80yo compared to 47.0% in patients <80yo (p<0.0001). All-cause mortality was 28.9% in the ≥80yo vs 12.9% in the < 80yo (p=0.006). Conclusion: In our cohort, the clinical outcomes among octogenarians receiving MT were worse than in younger patients despite no difference in recanalization. Various factors may be responsible including overall health status, comorbid conditions and neuroplasticity. Further prospective multicentral studies are needed to better understand the benefit of MT in octogenarians.

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