RT Journal Article
SR Electronic
T1 International experience of mechanical thrombectomy during the COVID-19 pandemic: insights from STAR and ENRG
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 1039
OP 1044
DO 10.1136/neurintsurg-2020-016671
VO 12
IS 11
A1 Al Kasab, Sami
A1 Almallouhi, Eyad
A1 Alawieh, Ali
A1 Levitt, Michael R
A1 Jabbour, Pascal
A1 Sweid, Ahmad
A1 Starke, Robert M
A1 Saini, Vasu
A1 Wolfe, Stacey Q
A1 Fargen, Kyle M
A1 Arthur, Adam S
A1 Goyal, Nitin
A1 Pandhi, Abhi
A1 Fragata, Isabel
A1 Maier, Ilko
A1 Matouk, Charles
A1 Grossberg, Jonathan A
A1 Howard, Brian M
A1 Kan, Peter
A1 Hafeez, Muhammad
A1 Schirmer, Clemens M
A1 Crowley, R Webster
A1 Joshi, Krishna C
A1 Tjoumakaris, Stavropoula I
A1 Chowdry, Shakeel
A1 Ares, William
A1 Ogilvy, Christopher
A1 Gomez-Paz, Santiago
A1 Rai, Ansaar T.
A1 Mokin, Maxim
A1 Guerrero, Waldo
A1 Park, Min S
A1 Mascitelli, Justin R
A1 Yoo, Albert
A1 Williamson, Richard
A1 Grande, Andrew Walker
A1 Crosa, Roberto Javier
A1 Webb, Sharon
A1 Psychogios, Marios N
A1 Ducruet, Andrew F
A1 Holmstedt, Christine A
A1 Ringer, Andrew J
A1 Spiotta, Alejandro M
A1 
YR 2020
UL http://jnis.bmj.com/content/12/11/1039.abstract
AB 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.