Thompson Lewis John Rubin, Houk Clifton, Ellens Nathaniel R, Kohli Gurkirat Singh, Schartz Derrek, Proper Diana, Bhalla Tarun, Bender Matthew T, Mattingly Thomas K
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United States.
Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States.
Front Neurol. 2025 Feb 24;16:1513124. doi: 10.3389/fneur.2025.1513124. eCollection 2025.
COVID-19 is an independent risk factor for ischemic stroke. Studies from early in the pandemic show increased rates of unfavorable recanalization, poor outcomes, and mortality in patients who were COVID-19 positive at the time of mechanical thrombectomy. However, there are currently no studies examining these parameters during the later pandemic when circulating variants were less virulent.
We performed a retrospective review of mechanical thrombectomies from 12/2020 to 3/2023. Patients who were COVID-19 positive at the time of thrombectomy were included. Demographic, procedural, and 90-day functional outcomes were evaluated.
Of 306 patients undergoing mechanical thrombectomy for acute ischemic stroke between 12/2020 and 3/2023, 18 were COVID-19 positive. Compared with the COVID-19 negative cohort, there were lower rates of favorable recanalization (73% vs. 92%, = 0.03) and good functional outcomes (26% vs. 49%, = 0.06), but greater tandem carotid pathology (42% vs. 12%, < 0.01), and a higher mortality rate (53% vs. 26%, = 0.02). However, COVID-19 positive status did not predict outcomes in multivariable analysis when controlled for age, NIHSS, IV tPA, recanalization status, and tandem carotid pathology.
Late in the pandemic, outcomes remained comparable to those observed in the early pandemic for patients positive for COVID-19 at the time of mechanical thrombectomy. This case series also demonstrates increased tandem carotid pathology in the COVID-19 cohort. While COVID-19 may not influence outcome to the degree that age and NIHSS do, the excess mortality continues to suggest a negative effect despite lower virulence.
新冠病毒病（COVID-19）是缺血性卒中的独立危险因素。疫情早期的研究表明，在机械取栓时COVID-19呈阳性的患者中，血管再通不良、预后不佳及死亡率有所增加。然而，目前尚无研究在疫情后期循环变异株毒性较低时对这些参数进行检测。
我们对2020年12月至2023年3月期间的机械取栓术进行了回顾性研究。纳入在取栓时COVID-19呈阳性的患者。评估患者的人口统计学、手术及90天功能结局。
在2020年12月至2023年3月期间因急性缺血性卒中接受机械取栓的306例患者中，18例COVID-19呈阳性。与COVID-19阴性队列相比，血管再通良好率较低（73%对92%，P = 0.03），功能结局良好率较低（26%对49%，P = 0.06），但串联颈动脉病变较多（42%对12%，P < 0.01），死亡率较高（53%对26%，P = 0.02）。然而，在对年龄、美国国立卫生研究院卒中量表（NIHSS）评分、静脉注射组织型纤溶酶原激活剂（IV tPA）、血管再通状态及串联颈动脉病变进行控制的多变量分析中，COVID-19阳性状态并不能预测结局。
在疫情后期，对于机械取栓时COVID-19呈阳性的患者，其结局与疫情早期观察到的结局相当。该病例系列还显示COVID-19队列中串联颈动脉病变增加。虽然COVID-19对结局的影响可能不如年龄和NIHSS评分，但尽管毒性较低，额外的死亡率仍提示存在负面影响。
