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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics
Arthur Wang1, Grace K Mandigo2, Peter D Yim3
1Department of Neurosurgery and Radiology, Columbia University Medical Center, New York, New York, USA aw3201@cumc.columbia.edu.
Insights
Patients with COVID-19 and large vessel occlusions presented with unique challenges, including younger age and increased clot fragmentation, making mechanical thrombectomy difficult. These findings highlight the complex nature of thromboembolic disease in COVID-19 patients.
Area of Science:
- Neurology
- Vascular Surgery
- Infectious Diseases
Background:
- COVID-19 infections are linked to thromboembolic events.
- Large vessel occlusions (LVOs) present a significant neurological emergency.
- Endovascular treatment is a key intervention for LVOs.
Observation:
- This study details the endovascular experience with five consecutive COVID-19 patients suffering LVOs.
- Patients exhibited coagulation abnormalities and presented with complex occlusion patterns.
- Mechanical thrombectomy was performed across anterior and posterior circulation territories.
Findings:
- The COVID-19 LVO cohort was younger (mean age 52.8 years) compared to historical controls.
- Occlusions included internal carotid artery, tandem thrombi, and multi-territory involvement.
- High rates of downstream emboli (100%) and clot fragmentation (40%) were observed, complicating revascularization.
Implications:
- COVID-19 associated LVOs present unique challenges for mechanical thrombectomy due to patient demographics and clot characteristics.
- Successful revascularization may be more difficult in this patient population.
- Further research is needed to optimize endovascular strategies for COVID-19 patients with LVOs.
Background:
COVID-19 infections have been shown to be associated with a range of thromboembolic disease.
Objective:
To describe our endovascular experience in a consecutive series of patients with COVID-19 who presented with large vessel occlusions, and to describe unique findings in this population.
Methods:
Mechanical thrombectomy was performed on five consecutive patients with COVID-19 with large vessel occlusions. A retrospective study of these patients was performed. Patient demographics, laboratory values, mechanical thrombectomy technique, and clinical and angiographic outcomes were reviewed.
Results:
Four patients with COVID-19 presented with anterior circulation occlusions and one patient with COVID-19 presented with both anterior and posterior circulation occlusions. All patients had coagulation abnormalities. Mean patient age was 52.8 years. Three patients presented with an intracranial internal carotid artery occlusion. Two patients presented with an intracranial occlusion and a tandem thrombus in the carotid bulb. One patient presented with an occlusion in both the internal carotid and basilar arteries. Clot fragmentation and distal emboli to a new vascular territory were seen in two of five (40%) patients, and downstream emboli were seen in all five (100%) patients. Patient clinical outcome was generally poor in this series of patients with COVID-19 large vessel occlusion.
Conclusion:
Our series of patients with COVID-19 demonstrated coagulation abnormalities, and compared with our previous experience with mechanical thrombectomy in large vessel occlusion, this group of patients were younger, had tandem or multiple territory occlusions, a large clot burden, and a propensity for clot fragmentation. These patients present unique challenges that make successful revascularization difficult.
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