Late pandemic COVID-19 positivity at the time of thrombectomy is associated with poor outcomes and tandem carotid pathology
ObjectivesCOVID-19 is an independent risk factor for ischemic stroke. Studies from early in the pandemic show increased rates of unfavorable recanalization, poor outcomes, and mortality in patients who were COVID-19 positive at the time of mechanical thrombectomy. However, there are currently no stu...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1513124/full |
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| author | Lewis John Rubin Thompson Clifton Houk Nathaniel R. Ellens Gurkirat Singh Kohli Derrek Schartz Diana Proper Tarun Bhalla Matthew T. Bender Thomas K. Mattingly |
| author_facet | Lewis John Rubin Thompson Clifton Houk Nathaniel R. Ellens Gurkirat Singh Kohli Derrek Schartz Diana Proper Tarun Bhalla Matthew T. Bender Thomas K. Mattingly |
| author_sort | Lewis John Rubin Thompson |
| collection | DOAJ |
| description | ObjectivesCOVID-19 is an independent risk factor for ischemic stroke. Studies from early in the pandemic show increased rates of unfavorable recanalization, poor outcomes, and mortality in patients who were COVID-19 positive at the time of mechanical thrombectomy. However, there are currently no studies examining these parameters during the later pandemic when circulating variants were less virulent.Materials and methodsWe performed a retrospective review of mechanical thrombectomies from 12/2020 to 3/2023. Patients who were COVID-19 positive at the time of thrombectomy were included. Demographic, procedural, and 90-day functional outcomes were evaluated.ResultsOf 306 patients undergoing mechanical thrombectomy for acute ischemic stroke between 12/2020 and 3/2023, 18 were COVID-19 positive. Compared with the COVID-19 negative cohort, there were lower rates of favorable recanalization (73% vs. 92%, p = 0.03) and good functional outcomes (26% vs. 49%, p = 0.06), but greater tandem carotid pathology (42% vs. 12%, p < 0.01), and a higher mortality rate (53% vs. 26%, p = 0.02). However, COVID-19 positive status did not predict outcomes in multivariable analysis when controlled for age, NIHSS, IV tPA, recanalization status, and tandem carotid pathology.ConclusionLate in the pandemic, outcomes remained comparable to those observed in the early pandemic for patients positive for COVID-19 at the time of mechanical thrombectomy. This case series also demonstrates increased tandem carotid pathology in the COVID-19 cohort. While COVID-19 may not influence outcome to the degree that age and NIHSS do, the excess mortality continues to suggest a negative effect despite lower virulence. |
| format | Article |
| id | doaj-art-0c0b8b62a73a44aa8ad663cde6f6f44c |
| institution | DOAJ |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj-art-0c0b8b62a73a44aa8ad663cde6f6f44c2025-08-20T03:10:53ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-02-011610.3389/fneur.2025.15131241513124Late pandemic COVID-19 positivity at the time of thrombectomy is associated with poor outcomes and tandem carotid pathologyLewis John Rubin Thompson0Clifton Houk1Nathaniel R. Ellens2Gurkirat Singh Kohli3Derrek Schartz4Diana Proper5Tarun Bhalla6Matthew T. Bender7Thomas K. Mattingly8Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United StatesObjectivesCOVID-19 is an independent risk factor for ischemic stroke. Studies from early in the pandemic show increased rates of unfavorable recanalization, poor outcomes, and mortality in patients who were COVID-19 positive at the time of mechanical thrombectomy. However, there are currently no studies examining these parameters during the later pandemic when circulating variants were less virulent.Materials and methodsWe performed a retrospective review of mechanical thrombectomies from 12/2020 to 3/2023. Patients who were COVID-19 positive at the time of thrombectomy were included. Demographic, procedural, and 90-day functional outcomes were evaluated.ResultsOf 306 patients undergoing mechanical thrombectomy for acute ischemic stroke between 12/2020 and 3/2023, 18 were COVID-19 positive. Compared with the COVID-19 negative cohort, there were lower rates of favorable recanalization (73% vs. 92%, p = 0.03) and good functional outcomes (26% vs. 49%, p = 0.06), but greater tandem carotid pathology (42% vs. 12%, p < 0.01), and a higher mortality rate (53% vs. 26%, p = 0.02). However, COVID-19 positive status did not predict outcomes in multivariable analysis when controlled for age, NIHSS, IV tPA, recanalization status, and tandem carotid pathology.ConclusionLate in the pandemic, outcomes remained comparable to those observed in the early pandemic for patients positive for COVID-19 at the time of mechanical thrombectomy. This case series also demonstrates increased tandem carotid pathology in the COVID-19 cohort. While COVID-19 may not influence outcome to the degree that age and NIHSS do, the excess mortality continues to suggest a negative effect despite lower virulence.https://www.frontiersin.org/articles/10.3389/fneur.2025.1513124/fullischemic strokeCOVID-19carotidendovascularmechanical thrombectomy |
| spellingShingle | Lewis John Rubin Thompson Clifton Houk Nathaniel R. Ellens Gurkirat Singh Kohli Derrek Schartz Diana Proper Tarun Bhalla Matthew T. Bender Thomas K. Mattingly Late pandemic COVID-19 positivity at the time of thrombectomy is associated with poor outcomes and tandem carotid pathology Frontiers in Neurology ischemic stroke COVID-19 carotid endovascular mechanical thrombectomy |
| title | Late pandemic COVID-19 positivity at the time of thrombectomy is associated with poor outcomes and tandem carotid pathology |
| title_full | Late pandemic COVID-19 positivity at the time of thrombectomy is associated with poor outcomes and tandem carotid pathology |
| title_fullStr | Late pandemic COVID-19 positivity at the time of thrombectomy is associated with poor outcomes and tandem carotid pathology |
| title_full_unstemmed | Late pandemic COVID-19 positivity at the time of thrombectomy is associated with poor outcomes and tandem carotid pathology |
| title_short | Late pandemic COVID-19 positivity at the time of thrombectomy is associated with poor outcomes and tandem carotid pathology |
| title_sort | late pandemic covid 19 positivity at the time of thrombectomy is associated with poor outcomes and tandem carotid pathology |
| topic | ischemic stroke COVID-19 carotid endovascular mechanical thrombectomy |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1513124/full |
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