Endovascular Thrombectomy of COVID-19-Related Large Vessel Occlusion: A Systematic Review and Summary of the Literature

Abstract

Purpose Despite an overall reduction in the number of stroke cases presenting to hospitals during the COVID-19 pandemic, a remarkably high incidence of acute cerebrovascular disease associated with the infection has been reported. In this systematic review, we assess the neurological outcomes and complications of endovascular thrombectomy (EVT) for large vessel occlusions (LVO) in COVID-19 patients. Methods A literature search was performed in PubMed from December 1, 2019 through September 1st, 2020 using different combinations of suitable keywords. Ten studies reporting EVT outcomes and complications were identified. Two studies that included non-LVO pathologies and COVID-19 negative patients with the outcomes analysis were excluded. Patient demographics, comorbidities, anatomic thrombus location, neurological and angiographic outcomes were assessed. Results A total of 8 studies, in addition to our institutional case series, were ultimately included in this review. The mean age was 62.2 years, of which 67.6% were males. M1 segment involvement was the most commonly reported (53.8%) thrombus location. The mean NIHSS at presentation was 20.4 with no significant change at 24 h. Successful revascularization (TICI ≥ 2b) was achieved in 89%. Early proximal cerebral re-occlusion was reported in 6 patients (11%) and cerebral hemorrhage in 3 patients (4%). In hospital mortality was reported in 15 patients (28.8%). Conclusion Despite angiographically successful EVT of LVOs in the majority of patients, this literature analysis demonstrates overall poor outcomes and high mortality in COVID-19 patients post EVT. An unusual incidence of early intracerebral proximal arterial re-occlusion was notable.

Letter: Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study

“…Patients with COVID-19 are younger and have a higher burden of risk factors, higher morbidity, and/or mortality compared with non–COVID-19 patients. In a previously published systematic review, overall poor outcomes and high mortality in patients with COVID-19 after endovascular thrombectomy (EVT) have been identified, 2 which keeps consistent with results in this study. Certainly, we would like to express our respect for the achievements.…”

Incidence and risk factors for stroke in patients with COVID-19 in the Philippines: An analysis of 10,881 cases

“…In this cohort, most strokes were embolic and attributed to cardiac dysfunction and paradoxical embolism from deep venous thrombosis. 10 , 21 , 22 However, these were not replicated in larger studies, including ours. Instead, COVID-19 stroke patients were found to have similar risk factors as those with stroke alone, indicating that COVID-19 may not or may only slightly increase the risk of stroke.…”

Reperfusion Therapies for Acute Ischemic Stroke in COVID-19 Patients: A Nationwide Multi-Center Study

“…Moreover, a lack of early neurological improvement was observed in other studies owing to several factors. Early consecutive ischemic strokes or re-occlusions of the same vessel after successful or complete recanalization were observed at a higher than expected rate of 8% in a systematic study [ 25 ]. In our cohort, we have no data regarding early re-occlusions in COVID-19 stroke patients, since this was a retrospective study and we do not routinely perform CTA after successful reperfusion according to national guidelines, unless there is a high clinical suspicion of re-occlusion.…”