Acute Ischemic Stroke and Endovascular Thrombectomy During COVID-19 Pandemic: A Nationwide Analysis

BACKGROUND AND OBJECTIVES: Infection with COVID-19 may be linked to both higher rates of severe strokes and strokes in younger patients through distinct pathophysiological processes. This study aims to investigate characteristics and outcomes in COVID-19–related acute ischemic stroke (AIS) and endovascular thrombectomy (EVT) included in the National Inpatient Sample database. METHODS: This is a retrospective population-based observational study that includes all patients with COVID-19 and patients with AIS with COVID-19 who underwent EVT and were admitted to hospitals included in the US National Inpatient Sample between 2020 and 2021. Primary outcomes include age difference and difference in cardiovascular risk factors between patients with AIS with and without COVID-19 and EVT patients with and without COVID-19. Secondary outcomes include rates of favorable hospital outcome (defined as discharge to home or acute rehabilitation facility), in-hospital mortality, and the length of hospital stay. RESULTS: A total of 1 381 039 patients with AIS were included. A total of 58 525 had a COVID-19 diagnosis. A total of 83 650 patients underwent EVT, and 3075 of these patients were diagnosed with COVID-19. The mean age for patients with COVID-19 with AIS was lower (67.55 vs 69.40 years; P < .001). There was a higher proportion of Black (21.1% vs 17.9%) and Hispanic patients (15.0% vs 8.5%) among the COVID-19 group of patients with AIS. In adjusted multivariable analyses, the presence of COVID-19 in patients with AIS was significantly associated with a higher rate of inpatient mortality (adjusted odds ratio (AOR): 2.79; 95% CI 2.61-2.98; P < .001) and a lower rate of favorable hospital outcome (AOR: 0.66; 95% CI 0.62-0.70; P < .001). Trend analysis shows that COVID-19–positive AIS cases decreased overall with the rise of the delta variant, but the number of COVID-19–positive AIS cases with the National Institutes of Health Stroke Scale equal to or greater than 10 rose drastically. CONCLUSION: This analysis demonstrates that patients with AIS and concomitant COVID-19 infection were younger, with fewer cardiovascular risk factors, and disproportionately Black and Hispanic, with worse neurological deficit and worse hospital outcome.