COVID-19 Affects Short-Term, But Not 90-Day, Outcome in Patients With Stroke Treated With Mechanical Thrombectomy.

Abstract

Background: COVID-19 is associated with an increased stroke risk. Moreover, outcome at discharge was worse in patients with large-vessel occlusion stroke with concomitant COVID-19 receiving endovascular treatment (ET). We aimed to investigate the impact of concomitant COVID-19 on later functional outcome in patients with large-vessel occlusion stroke treated with ET.

Methods: We analyzed patients from the GSR-ET (German Stroke Registry-Endovascular Treatment), an observational multicenter registry of patients with large-vessel occlusion stroke receiving ET. Baseline characteristics, procedural parameters, discharge parameters, and functional outcome at 90 days were compared between patients with concomitant COVID-19 and propensity score-matched controls (ratio, 1:4; matched for age, sex, prestroke modified Rankin Scale score, and stroke severity), and multivariable ordinal regression analysis was performed.

Results: Among 4010 patients receiving ET between February 2020 and December 2021, 72 (1.8%) had concomitant COVID-19. Compared with 224 matched patients without COVID-19, they (n=56) were more severely affected, with a higher median National Institutes of Health Stroke Scale (NIHSS) score after 24 hours (NIHSS score, 14.5 [interquartile range {IQR}, 9-22] versus 12 [IQR, 6-18.75]; P=0.015), and NIHSS score and modified Rankin Scale score at discharge (NIHSS score, 12 [IQR, 6.75-16.75] versus 6 [IQR, 2-13]; P=0.001; and modified Rankin Scale score, 5 [IQR, 4-5] versus 4 [IQR, 2-5]; P=0.023), but functional outcome at 90-day follow-up was similar (modified Rankin Scale score, 4 [IQR, 4-6] versus 4 [IQR, 2-6]; P=0.34). After adjustment for prespecified confounders, COVID-19 was associated with worse functional outcome at discharge (common odds ratio [OR], 0.40 [95% CI, 0.19-0.80]; P=0.011), but not at 90-day follow-up (common OR, 0.72 [95% CI, 0.32-1.60]; P=0.43).

Conclusions: COVID-19 affected short-term, but not 90-day, functional outcome in patients with large-vessel occlusion stroke treated with ET. Hence, ET should not be withheld in patients with concomitant COVID-19.