ABSTRACT
Background The mechanisms and outcomes in COVID-19- associated stroke are unique from those of non-COVID-19 stroke. Objectives The purpose of this study is to describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. Methods We conducted an international multicenter retrospective study of consecutively admitted COVID-19 patients with concomitant acute large vessel occlusion (LVO) across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a MT between January 2018 to December 2020.Results: The total cohort was 575 patients with acute LVO, 194 had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs. 71.2;p<0.001), and lacked vascular risk factors (49, 25.3% vs. 54, 14.2%;p =0.001). mTICI 3 revascularization was less common in the COVID-19 group (74, 39.2% vs. 252, 67.2%;p < 0.001). Poor functional outcome at discharge (defined as mRS 3-6) was more common in the COVID-19 group (150, 79.8% vs.132, 66.7%;p =0.004). COVID-19 was independently associated with a lower likelihood of achieving mTICI 3 (OR: 0.4, 95% CI: 0.2 -0.7;p<0.001), and unfavorable outcomes (OR: 2.5, 95% CI: 1.4 - 4.5;p=0.002). Conclusion COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. COVID-19 patients with LVO patients were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates. (Figure Presented).