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International experience of mechanical thrombectomy during the COVID-19 pandemic: insights from STAR and ENRG.
Al Kasab, Sami; Almallouhi, Eyad; Alawieh, Ali; Levitt, Michael R; Jabbour, Pascal; Sweid, Ahmad; Starke, Robert M; Saini, Vasu; Wolfe, Stacey Q; Fargen, Kyle M; Arthur, Adam S; Goyal, Nitin; Pandhi, Abhi; Fragata, Isabel; Maier, Ilko; Matouk, Charles; Grossberg, Jonathan A; Howard, Brian M; Kan, Peter; Hafeez, Muhammad; Schirmer, Clemens M; Crowley, R Webster; Joshi, Krishna C; Tjoumakaris, Stavropoula I; Chowdry, Shakeel; Ares, William; Ogilvy, Christopher; Gomez-Paz, Santiago; Rai, Ansaar T; Mokin, Maxim; Guerrero, Waldo; Park, Min S; Mascitelli, Justin R; Yoo, Albert; Williamson, Richard; Grande, Andrew Walker; Crosa, Roberto Javier; Webb, Sharon; Psychogios, Marios N; Ducruet, Andrew F; Holmstedt, Christine A; Ringer, Andrew J; Spiotta, Alejandro M.
  • Al Kasab S; Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
  • Almallouhi E; Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
  • Alawieh A; Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
  • Levitt MR; Neurosurgery, Emory University, Atlanta, Georgia, USA.
  • Jabbour P; Microbiology and Immunology, Medical University of South Carolina, South Carolina, USA.
  • Sweid A; Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
  • Starke RM; Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
  • Saini V; Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
  • Wolfe SQ; Neurological Surgery, University of Miami Miller School of Medicine, Miami Beach, Florida, USA.
  • Fargen KM; University of Miami Miller School of Medicine, Miami, Florida, USA.
  • Arthur AS; University of Miami Miller School of Medicine, Miami, Florida, USA.
  • Goyal N; Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
  • Pandhi A; Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
  • Fragata I; Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
  • Maier I; Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
  • Matouk C; Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
  • Grossberg JA; Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
  • Howard BM; Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
  • Kan P; Neurology, University Medicine Goettingen, Goettingen, NS, Germany.
  • Hafeez M; Neurosurgery, Yale University, New Haven, Connecticut, USA.
  • Schirmer CM; Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Crowley RW; Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Joshi KC; Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Tjoumakaris SI; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
  • Chowdry S; Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
  • Ares W; Neurosurgery, Geisinger Health System, Wilkes-Barre, Pennsylvania, USA.
  • Ogilvy C; Rush University, Chicago, Illinois, USA.
  • Gomez-Paz S; Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
  • Rai AT; Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
  • Mokin M; North Shore University Health System, Evanston, Illinois, USA.
  • Guerrero W; Neurosurgery, North Shore University Health System, Evanston, Illinois, USA.
  • Park MS; Neurosurgery, BIDMC, Boston, Massachusetts, USA.
  • Mascitelli JR; Neurosurgery, BIDMC, Boston, Massachusetts, USA.
  • Yoo A; Department of Neurointerventional Radiology, West Virginia University, Morgantown, West Virginia, USA.
  • Williamson R; Neurosurgery, University of South Florida, Tampa, Florida, USA.
  • Grande AW; Neurosurgery, University of South Florida, Tampa, Florida, USA.
  • Crosa RJ; Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
  • Webb S; Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
  • Psychogios MN; Texas Stroke Institute, Fort Worth, Texas, USA.
  • Ducruet AF; Stroke & Cerebrovascular Center, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
  • Holmstedt CA; Neurosurgery, Radiology and Neurology, University of Minnesota, Mendota Heights, Minnesota, USA.
  • Ringer AJ; Endovascular Neurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay.
  • Spiotta AM; Neurosurgery, Bon Secours St Francis Hospital, Greenville, South Carolina, USA.
J Neurointerv Surg ; 12(11): 1039-1044, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-742246
Semantic information from SemMedBD (by NLM)
1. Cerebrovascular accident PROCESS_OF Patients
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Patients
2. Mechanical thrombectomy ADMINISTERED_TO Patients
Subject
Mechanical thrombectomy
Predicate
ADMINISTERED_TO
Object
Patients
3. General Anesthesia TREATS Patients
Subject
General Anesthesia
Predicate
TREATS
Object
Patients
4. Mechanical thrombectomy TREATS Cerebrovascular accident
Subject
Mechanical thrombectomy
Predicate
TREATS
Object
Cerebrovascular accident
5. Mechanical thrombectomy TREATS Patients
Subject
Mechanical thrombectomy
Predicate
TREATS
Object
Patients
6. Mechanical thrombectomy TREATS Liver carcinoma
Subject
Mechanical thrombectomy
Predicate
TREATS
Object
Liver carcinoma
7. Intubation TREATS Patients
Subject
Intubation
Predicate
TREATS
Object
Patients
8. Cerebrovascular accident PROCESS_OF Patients
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Patients
9. Mechanical thrombectomy ADMINISTERED_TO Patients
Subject
Mechanical thrombectomy
Predicate
ADMINISTERED_TO
Object
Patients
10. General Anesthesia TREATS Patients
Subject
General Anesthesia
Predicate
TREATS
Object
Patients
11. Mechanical thrombectomy TREATS Cerebrovascular accident
Subject
Mechanical thrombectomy
Predicate
TREATS
Object
Cerebrovascular accident
12. Mechanical thrombectomy TREATS Patients
Subject
Mechanical thrombectomy
Predicate
TREATS
Object
Patients
13. Mechanical thrombectomy TREATS Liver carcinoma
Subject
Mechanical thrombectomy
Predicate
TREATS
Object
Liver carcinoma
14. Intubation TREATS Patients
Subject
Intubation
Predicate
TREATS
Object
Patients
ABSTRACT

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.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Pneumonia, Viral / Thrombectomy / Coronavirus Infections / Stroke / Pandemics Subject: Pneumonia, Viral / Thrombectomy / Coronavirus Infections / Stroke / Pandemics Type of study: Observational study / Prognostic study / Risk factors Language: English Journal: J Neurointerv Surg Year: 2020

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Pneumonia, Viral / Thrombectomy / Coronavirus Infections / Stroke / Pandemics Subject: Pneumonia, Viral / Thrombectomy / Coronavirus Infections / Stroke / Pandemics Type of study: Observational study / Prognostic study / Risk factors Language: English Journal: J Neurointerv Surg Year: 2020
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