Three-month functional outcomes following endovascular thrombectomy during the first wave of the COVID-19 pandemic: a Canadian single-center cohort study

Abstract

BackgroundThe COVID-19 pandemic has disrupted acute stroke care logistics, including delays in hyperacute management and decreased monitoring following endovascular therapy (EVT). We aimed to assess the impact of the pandemic on 90-day functional outcome among patients treated with EVT.MethodsThis is an observational cohort study including all patients evaluated for an acute stroke between March 30, 2020 and September 30, 2020 (pandemic cohort) and 2019 (reference cohort) in a high-volume Canadian academic stroke center. We collected baseline characteristics, acute reperfusion treatment and management metrics. For EVT-treated patients, we assessed the modified Rankin score (mRS) at 90 days. We evaluated the impact of the pandemic on a 90-day favourable functional status (defined as mRS 0–2) and death using multivariable logistic regressions.ResultsAmong 383 and 339 patients included in the pandemic and reference cohorts, baseline characteristics were similar. Delays from symptom onset to evaluation and in-house treatment were longer during the early first wave, but returned to reference values in the subsequent months. Among the 127 and 136 EVT-treated patients in each respective cohort, favourable 90-day outcome occurred in 53/99 (53%) vs 52/109 (48%, p=0.40), whereas 22/99 (22%) and 28/109 (26%, p=0.56) patients died. In multivariable regressions, the pandemic period was not associated with 90-day favourable functional status (aOR 1.27, 95% CI 0.60 to 2.56) or death (aOR 0.74, 95% CI 0.33 to 1.63).ConclusionIn this single-center cohort study conducted in a Canadian pandemic epicenter, the first 6 months of the COVID-19 pandemic did not impact 90-day functional outcomes or death among EVT-treated patients.

Mechanical Thrombectomy in Acute Ischemic Stroke COVID-19 and Non-COVID-19 Patients: A Single Comprehensive Stroke Center Study

“…Our laboratory analysis was in accordance with these studies. When analyzing the outcome of mechanical thrombectomy procedures, our report showed similar results to some studies regarding a favorable recanalization mTICI score (>2B), which was comparable in COVID-19 and non-COVID-19 groups, as reported earlier [ 11 , 36 , 37 ]. Studies, including ours, did not find a correlation between procedure-related complications such as sICH or SAH [ 11 , 12 , 36 , 37 ], and occurrence of ICH was comparable with large studies [ 38 ].…”

“…When analyzing the outcome of mechanical thrombectomy procedures, our report showed similar results to some studies regarding a favorable recanalization mTICI score (>2B), which was comparable in COVID-19 and non-COVID-19 groups, as reported earlier [ 11 , 36 , 37 ]. Studies, including ours, did not find a correlation between procedure-related complications such as sICH or SAH [ 11 , 12 , 36 , 37 ], and occurrence of ICH was comparable with large studies [ 38 ]. The modified Rankin Scale score, as a rank of functional independence after AIS, showed no difference between our groups, as previously reported [ 37 ], although some studies reported higher mortality rate in COVID-19 patients [ 25 , 36 ].…”

“…Studies, including ours, did not find a correlation between procedure-related complications such as sICH or SAH [ 11 , 12 , 36 , 37 ], and occurrence of ICH was comparable with large studies [ 38 ]. The modified Rankin Scale score, as a rank of functional independence after AIS, showed no difference between our groups, as previously reported [ 37 ], although some studies reported higher mortality rate in COVID-19 patients [ 25 , 36 ]. Larger groups of patients should be investigated to establish the correlation between SARS-CoV-2 infection and higher mortality after acute ischemic stroke.…”

Mechanical thrombectomy for acute ischemic stroke in COVID-19 patients: multicenter experience in 111 cases

“…Second, MT in patients with acute severe COVID-19 infection could be complicated by diagnostic delays imposed by the fact that these patients are more likely to be sedated and intubated, thus impeding the early detection of neurological deterioration. Third, the COVID-19 pandemic compromised the application of well-established therapies and appears to be disruptive for acute stroke pathways 13–15. Stroke patients without respiratory symptoms of COVID-19 might not seek care at all, preferring to stay at home than taking the risk of getting exposed to SARS-CoV-2 at the hospital.…”

Impact on functional outcome of an adaptive Stroke Unit based system of care for patients undergoing endovascular treatment during pandemic times

“…11 However, other centers that maintained a traditional protocol that uses CS as first choice, reserving GA for airway, respiratory or hemodynamic compromise, did not suffer an impact of the pandemic in functional outcome among EVT treated patients. 13…”