COVID-19 Affects Short-Term, But Not 90-Day, Outcome in Patients With Stroke Treated With Mechanical Thrombectomy

COVID-19 is associated with an increased stroke risk. Moreover, outcome at discharge was worse in patients with large-vessel occlusion stroke with concomitant COVID-19 receiving endovascular treatment (ET). We aimed to investigate the impact of concomitant COVID-19 on later functional outcome in patients with large-vessel occlusion stroke treated with ET.

We analyzed patients from the GSR-ET (German Stroke Registry-Endovascular Treatment), an observational multicenter registry of patients with large-vessel occlusion stroke receiving ET. Baseline characteristics, procedural parameters, discharge parameters, and functional outcome at 90 days were compared between patients with concomitant COVID-19 and propensity score-matched controls (ratio, 1:4; matched for age, sex, prestroke modified Rankin Scale score, and stroke severity), and multivariable ordinal regression analysis was performed.

Among 4010 patients receiving ET between February 2020 and December 2021, 72 (1.8%) had concomitant COVID-19. Compared with 224 matched patients without COVID-19, they (n=56) were more severely affected, with a higher median National Institutes of Health Stroke Scale (NIHSS) score after 24 hours (NIHSS score, 14.5 [interquartile range {IQR}, 9-22] versus 12 [IQR, 6-18.75]; P=0.015), and NIHSS score and modified Rankin Scale score at discharge (NIHSS score, 12 [IQR, 6.75-16.75] versus 6 [IQR, 2-13]; P=0.001; and modified Rankin Scale score, 5 [IQR, 4-5] versus 4 [IQR, 2-5]; P=0.023), but functional outcome at 90-day follow-up was similar (modified Rankin Scale score, 4 [IQR, 4-6] versus 4 [IQR, 2-6]; P=0.34). After adjustment for prespecified confounders, COVID-19 was associated with worse functional outcome at discharge (common odds ratio [OR], 0.40 [95% CI, 0.19-0.80]; P=0.011), but not at 90-day follow-up (common OR, 0.72 [95% CI, 0.32-1.60]; P=0.43).

COVID-19 affected short-term, but not 90-day, functional outcome in patients with large-vessel occlusion stroke treated with ET. Hence, ET should not be withheld in patients with concomitant COVID-19.