Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study

Pascal Jabbour, Adam A. Dmytriw, Ahmad Sweid, Michel Piotin, Kimon Bekelis, Nader Sourour, Eytan Raz, Italo Linfante, Guilherme Dabus, Max Kole, Mario Martínez-Galdámez, Shahid M. Nimjee, Demetrius K. Lopes, Ameer E. Hassan, Peter Kan, Mohammad Ghorbani, Michael R. Levitt, Simon Escalard, Symeon Missios, Maksim ShapiroFrédéric Clarençon, Mahmoud Elhorany, Daniel Vela-Duarte, Rizwan A. Tahir, Patrick P. Youssef, Aditya S. Pandey, Robert M. Starke, Kareem El Naamani, Rawad Abbas, Bassel Hammoud, Ossama Y. Mansour, Jorge Galvan, Joshua T. Billingsley, Abolghasem Mortazavi, Mahmoud Dibas, Fabio Settecase, Manraj K.S. Heran, Anna L. Kuhn, Ajit S. Puri, Bijoy K. Menon, Sanjeev Sivakumar, Ashkan Mowla, Salvatore D'amato, Alicia M. Zha, Daniel Cooke, Mayank Goyal, Hannah Wu, Jake Cohen, David Turkel-Parrella, Andrew Xavier, Muhammad Waqas, Vincent M. Tutino, Adnan Siddiqui, Gaurav Gupta, Anil Nanda, Priyank Khandelwal, Cristina Tiu, Pere C. Portela, Natalia Perez De La Ossa, Xabier Urra, Mercedes De Lera, Juan F. Arenillas, Marc Ribo, Manuel Requena, Mariangela Piano, Guglielmo Pero, Keith De Sousa, Fawaz Al-Mufti, Zafar Hashim, Sanjeev Nayak, Leonardo Renieri, Mohamed A. Aziz-Sultan, Thanh N. Nguyen, Patricia Feineigle, Aman B. Patel, James E. Siegler, Khodr Badih, Jonathan A. Grossberg, Hassan Saad, M. Reid Gooch, Nabeel A. Herial, Robert H. Rosenwasser, Stavropoula Tjoumakaris, Ambooj Tiwari

Research output: Contribution to journalArticlepeer-review


BACKGROUND: The mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke. OBJECTIVE: To describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. METHODS: We conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020. RESULTS: The total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P <.001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P =.001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P <.001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P =.004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P <.001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P =.002). CONCLUSION: COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.

Original languageEnglish (US)
Pages (from-to)725-733
Number of pages9
Issue number6
StatePublished - Jun 1 2022
Externally publishedYes


  • COVID-19
  • Central nervous system
  • Cerebrovascular disease
  • Hypercoagulable
  • SARS-CoV-2

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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