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Research ArticleNeurointervention
Open Access

Stroke Thrombectomy in Patients with COVID-19: Initial Experience in 13 Cases

R. Pop, A. Hasiu, F. Bolognini, D. Mihoc, V. Quenardelle, R. Gheoca, E. Schluck, S. Courtois, M. Delaitre, M. Musacchio, J. Pottecher, T.-N. Chamaraux-Tran, F. Sellal, V. Wolff, P.A. Lebedinsky and R. Beaujeux
American Journal of Neuroradiology November 2020, 41 (11) 2012-2016; DOI: https://doi.org/10.3174/ajnr.A6750
R. Pop
aFrom the Interventional Neuroradiology Department (R.P., A.H., D.M., R.B.)
dInstitut de Chirurgie Minime Invasive Guidée par l’Image (R.P., R.B.), Strasbourg, France
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A. Hasiu
aFrom the Interventional Neuroradiology Department (R.P., A.H., D.M., R.B.)
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F. Bolognini
eDiagnostic and Interventional Neuroradiology Department (F.B., M.D., M.M., P.A.L.)
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  • ORCID record for F. Bolognini
D. Mihoc
aFrom the Interventional Neuroradiology Department (R.P., A.H., D.M., R.B.)
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V. Quenardelle
bStroke Unit (V.Q., R.G., V.W.)
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  • ORCID record for V. Quenardelle
R. Gheoca
bStroke Unit (V.Q., R.G., V.W.)
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E. Schluck
gNeurology Department (E.S., S.C.), Emile Muller Hospital, Mulhouse, France
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S. Courtois
gNeurology Department (E.S., S.C.), Emile Muller Hospital, Mulhouse, France
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  • ORCID record for S. Courtois
M. Delaitre
eDiagnostic and Interventional Neuroradiology Department (F.B., M.D., M.M., P.A.L.)
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M. Musacchio
eDiagnostic and Interventional Neuroradiology Department (F.B., M.D., M.M., P.A.L.)
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  • ORCID record for M. Musacchio
J. Pottecher
cDepartment of Anesthesia (J.P., T.-N.C.-T.), Strasbourg University Hospitals, Strasbourg, France
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T.-N. Chamaraux-Tran
cDepartment of Anesthesia (J.P., T.-N.C.-T.), Strasbourg University Hospitals, Strasbourg, France
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F. Sellal
fNeurology Department (F.S.), Hôpitaux Civils de Colmar, Colmar, France
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V. Wolff
bStroke Unit (V.Q., R.G., V.W.)
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P.A. Lebedinsky
eDiagnostic and Interventional Neuroradiology Department (F.B., M.D., M.M., P.A.L.)
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R. Beaujeux
aFrom the Interventional Neuroradiology Department (R.P., A.H., D.M., R.B.)
dInstitut de Chirurgie Minime Invasive Guidée par l’Image (R.P., R.B.), Strasbourg, France
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Article Figures & Data

Tables

    • View popup
    Table 1:

    Baseline characteristics

    Thrombectomies in Patients with COVID-19 (n = 13)
    Age (median) (IQR) (yr)78 (71–79)
    Male sex (No.) (%)5 (38.4%)
    Risk factors (No.) (%)
     Hypertension8 (61.5%)
     Dyslipidemia3 (23.0%)
     Diabetes2 (15.3%)
     Smoking3 (23.0%)
    Baseline mRS score >20 (0%)
    Baseline NIHSS score (median) (IQR)13 (7–15)
    Symptom onset to femoral puncture (median) (IQR) (min)244 (232–290)
    IV thrombolysis (No.) (%)4 (30.7%)
    Initial imaging type (No.) (%)
     MR imaging11 (84.6%)
     CT2 (15.3%)
    Initial APECTSa
     ASPECTS <5 (n/N) (%)0/12 (0%)
     ASPECTS score (median) (IQR)8 (5.7–9)
    Occlusion site at angiography (No) (%)
     M1 segment8 (61.5%)
     M2 segment3 (23.0%)
     Tandem occlusion1 (7.6%)
     Basilar trunk1 (7.6%)
    • Note:—IQR indicates interquartile range; n/N, n - number of cases with ASPECTS <5/N - number of cases with anterior circulation strokes.

    • ↵a For anterior circulation strokes.

    • View popup
    Table 2:

    Thrombectomy procedure metrics: clinical and radiologic outcomes

    Thrombectomies in Patients with COVID-19 (n = 13)
    Anesthesia method (No.) (%)
     General anesthesia9 (69.2%)
     Conscious sedation4 (30.7%)
    Initial treatment approach (No.) (%)
     Stent retriever4 (30.7%)
     ADAPT technique6 (46.1%)
     Combined distal aspiration and stent retriever3 (23.0%)
    Timing of intervention (median) (IQR)( min)
     Femoral puncture to recanalization34.5 (23–45)
     Symptom onset to recanalization298.5 (261–324)
    Angiographic outcome (No.) (%)
     TICI 2b–310 (76.9%)
     TICI 2c–39 (69.2%)
     TICI 37 (53.8%)
    Procedural complications (No.) (%)
     Neurologic0 (0%)
     Non-neurologic (femoral artery occlusion)1 (7.6%)
    Imaging outcome (No). (%)
     All hemorrhagic transformation3 (23.0%)
     Symptomatic ICH0 (0%)
     HI1–HI22 (15.3%)
     PH 11 (7.6%)
     PH 20 (0%)
    Clinical outcome
     In-hospital mortality (No.) (%)2 (15.3%)
     Last available NIHSS (median) (IQR)a5 (0.5–12.5)
     NIHSS drop (median) (IQR)a2 (0.5–5)
    • Note:—ADAPT indicates direct aspiration first pass technique; ICH, intracerebral hemorrhage; PH, parenchymal hematoma; HI, petechial hemorrhage.

    • ↵a n = 10 (excluding 2 deceased patients).

    • View popup
    Table 3:

    Influence of COVID-19 epidemic on mechanical thrombectomy volumes and procedural time metrics

    March 1 to April 26, 2019March 1 to April 26, 2020Variation/P Value
    Volume of mechanical thrombectomies4334–21%
    Symptom onset to brain imaging (median) (IQR) (min)141 (102–189)135 (100–171).568
    Symptom onset to IV thrombolysisa (median) (IQR) (min)167 (141–188)162 (150–180).992
    Imaging to femoral puncture (median) (IQR) (min)102 (82–137)113 (96–138).316
    Symptom onset to femoral puncture (median) (IQR) (min)257 (207–298)258 (211–293).919
    Femoral puncture to recanalization (median) (IQR) (min)48 (39–71)43 (25–58).363
    • ↵a For patients who received IV thrombolysis before thrombectomy.

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American Journal of Neuroradiology: 41 (11)
American Journal of Neuroradiology
Vol. 41, Issue 11
1 Nov 2020
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Stroke Thrombectomy in Patients with COVID-19: Initial Experience in 13 Cases
R. Pop, A. Hasiu, F. Bolognini, D. Mihoc, V. Quenardelle, R. Gheoca, E. Schluck, S. Courtois, M. Delaitre, M. Musacchio, J. Pottecher, T.-N. Chamaraux-Tran, F. Sellal, V. Wolff, P.A. Lebedinsky, R. Beaujeux
American Journal of Neuroradiology Nov 2020, 41 (11) 2012-2016; DOI: 10.3174/ajnr.A6750
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R. Pop, A. Hasiu, F. Bolognini, D. Mihoc, V. Quenardelle, R. Gheoca, E. Schluck, S. Courtois, M. Delaitre, M. Musacchio, J. Pottecher, T.-N. Chamaraux-Tran, F. Sellal, V. Wolff, P.A. Lebedinsky, R. Beaujeux
Stroke Thrombectomy in Patients with COVID-19: Initial Experience in 13 Cases
American Journal of Neuroradiology Nov 2020, 41 (11) 2012-2016; DOI: 10.3174/ajnr.A6750

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