Effect of SARS-CoV-2 Infection on Endovascular Thrombectomy Outcomes-Data from the Florida Stroke Registry.

Abstract

Background and purpose: Endovascular thrombectomy outcomes are impacted by changes in stroke systems of care. During the pandemic, SARS-CoV-2 positive status had major implications on hospital arrival and treatment models of non-COVID-related hospital admissions. Using the Florida Stroke Registry, we compared the rates of in-hospital death and discharge outcomes of patients treated with endovascular thrombectomy who tested positive for SARS-CoV-2 infection during their hospitalization.

Materials and methods: Data from Get with the Guidelines-Stroke hospitals participating in the Florida Stroke Registry during the COVID pandemic from March 2020 to December 2022 were reviewed to identify endovascular thrombectomy patients with coding for SARS-CoV-2 testing during their hospital stay. Associations between SARS-CoV-2 status and favorable endovascular thrombectomy outcomes of mRS (0-2) at discharge, discharge to home or rehabilitation center, symptomatic intracerebral hemorrhage, in-hospital mortality, and independent ambulation at discharge were examined by using multivariate logistic regression modeling adjusting for demographics, vascular risk factors, and clinical characteristics. Temporal analyses were used to compare outcomes across the study period.

Results: A total of 8184 patients underwent endovascular thrombectomy (median age 71.1 years, women 49.7%, mean NIHSS 14). Of these, 180 (2.20%) were SARS-CoV-2 positive. Compared with SARS-CoV-2 negative endovascular thrombectomy patients, those who tested positive were younger, more frequently men, but with comparable stroke severity at presentation. In multivariable analysis, adjusting for baseline differences and confounding variables, there was a 33% lower likelihood of being discharged to home/inpatient rehab (OR = 0.67, 95% CI: 0.49-0.93), 65% higher odds of in-hospital death (OR = 1.65, 95% CI: 1.06-2.58), as well as a 91% less chance of having a high mRS (>2) at discharge (OR = 0.15, 95% CI: 0.04-0.60) for patients with positive SARS-CoV-2 infection. However, a similar risk of symptomatic intracerebral hemorrhage was present compared with SARS-CoV-2 negative patients (OR = 0.97, 95% CI: 0.50-1.88). Temporal analysis of SARS-CoV-2 positive patients showed no significant differences.

Conclusions: In this large multicenter stroke registry, despite comparable clinical presentation and treatment timelines, SARS-CoV2 positive status negatively impacted thrombectomy outcomes.