Objective:

To evaluate the impact of concurrent COVID-19 infection on mechanical thrombectomy outcomes among patients with ischemic stroke in our hospital system.

Background:

COVID-19 is associated with hypercoagulability and an increased risk of acute ischemic stroke (AIS). During the pandemic, stroke admissions declined overall, but a higher proportion of acute ischemic strokes were linked to COVID-19, with affected patients experiencing worse outcomes. Mechanical thrombectomy (MT) is routinely performed in AIS patients with large vessel occlusions (LVO). This study evaluates the impact of COVID-19 infection on treatment with mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS), as well as the therapeutic outcomes within our hospital system.

Design/Methods:

This retrospective cohort study included AIS patients requiring MT between January 2020 and December 2023, identified from the institutional Stroke Log. Data from COVID-19 positive and negative patients were compared for demographics, NIHSS, pre/post mRS (modified Rankin Score), TICI (Thrombolysis in Cerebral Infarction) score and mortality.

Results:

Among AIS patients, 25% of COVID-19-positive patients required MT compared to 13% of COVID-19-negative patients, though the difference was not statistically significant. Mortality was higher in COVID-19-positive patients (33% vs. 15%). Odds ratios indicated higher likelihood of both thrombectomy and mortality in COVID-19-positive patients, but results did not reach statistical significance.

Conclusions:

COVID-19 complicates AIS management, with patients undergoing MT showing nearly double the mortality rate compared to non-infected counterparts. Although statistical significance was not achieved due to limited sample size, the findings suggest clinically meaningful differences. Poor MT outcomes in COVID-19 patients may be related to delayed presentation, higher clot burden, and/or concurrent respiratory compromise.