Late pandemic COVID-19 positivity at the time of thrombectomy is associated with poor outcomes and tandem carotid pathology

Lewis John Rubin Thompson; Clifton Houk; Nathaniel R Ellens; Gurkirat Singh Kohli; Derrek Schartz; Diana Proper; Tarun Bhalla; Matthew T Bender; Thomas K Mattingly

doi:10.3389/fneur.2025.1513124

Late pandemic COVID-19 positivity at the time of thrombectomy is associated with poor outcomes and tandem carotid pathology

Front Neurol. 2025 Feb 24:16:1513124. doi: 10.3389/fneur.2025.1513124. eCollection 2025.

Authors

Lewis John Rubin Thompson¹, Clifton Houk¹, Nathaniel R Ellens¹, Gurkirat Singh Kohli¹, Derrek Schartz², Diana Proper¹, Tarun Bhalla¹, Matthew T Bender¹, Thomas K Mattingly¹

Affiliations

¹ Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United States.
² Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States.

Abstract

Objectives: 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.

Materials and methods: 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.

Results: 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%, p = 0.03) and good functional outcomes (26% vs. 49%, p = 0.06), but greater tandem carotid pathology (42% vs. 12%, p < 0.01), and a higher mortality rate (53% vs. 26%, p = 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.

Conclusion: 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.

Keywords: COVID-19; carotid; endovascular; ischemic stroke; mechanical thrombectomy.