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Updated: Jan 12, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Acute Ischemic Stroke and Endovascular Thrombectomy During COVID-19 Pandemic: A Nationwide Analysis
Preethi Reddi1, Amol Mehta1, Trevor Hardigan1
1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Patients with acute ischemic stroke (AIS) and COVID-19 were younger and had worse outcomes, including higher mortality and lower favorable hospital outcomes. This highlights disparities in stroke care and outcomes related to COVID-19 infection.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- COVID-19 infection is associated with increased risk of severe strokes.
- Distinct pathophysiological processes may link COVID-19 to strokes in younger individuals.
- Understanding COVID-19's impact on stroke characteristics and outcomes is crucial.
Purpose of the Study:
- To investigate the characteristics and outcomes of COVID-19-related acute ischemic stroke (AIS).
- To analyze patients undergoing endovascular thrombectomy (EVT) with and without COVID-19.
- To compare demographic and clinical factors between AIS patients with and without COVID-19.
Main Methods:
- Retrospective, population-based observational study using the US National Inpatient Sample (2020-2021).
- Inclusion of all patients with COVID-19 and AIS patients who underwent EVT.
- Primary outcomes: age, cardiovascular risk factors; Secondary outcomes: hospital outcome, mortality, length of stay.
Main Results:
- COVID-19 patients with AIS were younger (67.55 vs 69.40 years) and had higher proportions of Black and Hispanic individuals.
- COVID-19 in AIS patients was linked to increased inpatient mortality (AOR: 2.79) and decreased favorable hospital outcomes (AOR: 0.66).
- COVID-19-positive AIS cases decreased with the Delta variant, but severe cases (NIHSS ≥ 10) increased.
Conclusions:
- Patients with AIS and COVID-19 were younger, had fewer cardiovascular risk factors, and were disproportionately from minority groups.
- Concomitant COVID-19 infection in AIS patients was associated with worse neurological deficits and poorer hospital outcomes.
- Findings underscore the significant impact of COVID-19 on stroke severity and patient outcomes.
Background And Objectives:
Infection with COVID-19 may be linked to both higher rates of severe strokes and strokes in younger patients through distinct pathophysiological processes. This study aims to investigate characteristics and outcomes in COVID-19-related acute ischemic stroke (AIS) and endovascular thrombectomy (EVT) included in the National Inpatient Sample database.
Methods:
This is a retrospective population-based observational study that includes all patients with COVID-19 and patients with AIS with COVID-19 who underwent EVT and were admitted to hospitals included in the US National Inpatient Sample between 2020 and 2021. Primary outcomes include age difference and difference in cardiovascular risk factors between patients with AIS with and without COVID-19 and EVT patients with and without COVID-19. Secondary outcomes include rates of favorable hospital outcome (defined as discharge to home or acute rehabilitation facility), in-hospital mortality, and the length of hospital stay.
Results:
A total of 1 381 039 patients with AIS were included. A total of 58 525 had a COVID-19 diagnosis. A total of 83 650 patients underwent EVT, and 3075 of these patients were diagnosed with COVID-19. The mean age for patients with COVID-19 with AIS was lower (67.55 vs 69.40 years; P < .001). There was a higher proportion of Black (21.1% vs 17.9%) and Hispanic patients (15.0% vs 8.5%) among the COVID-19 group of patients with AIS. In adjusted multivariable analyses, the presence of COVID-19 in patients with AIS was significantly associated with a higher rate of inpatient mortality (adjusted odds ratio (AOR): 2.79; 95% CI 2.61-2.98; P < .001) and a lower rate of favorable hospital outcome (AOR: 0.66; 95% CI 0.62-0.70; P < .001). Trend analysis shows that COVID-19-positive AIS cases decreased overall with the rise of the delta variant, but the number of COVID-19-positive AIS cases with the National Institutes of Health Stroke Scale equal to or greater than 10 rose drastically.
Conclusion:
This analysis demonstrates that patients with AIS and concomitant COVID-19 infection were younger, with fewer cardiovascular risk factors, and disproportionately Black and Hispanic, with worse neurological deficit and worse hospital outcome.
