Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis of Stent Retrievers vs Direct Aspiration vs a Combined Approach

Abstract BACKGROUND Recent randomized control trials (RCTs) established that mechanical thrombectomy is superior to medical therapy for patients with stroke due to a large vessel occlusion. OBJECTIVE To compare the safety and efficacy profile of the different mechanical thrombectomy strategies. METHODS A random-effects meta-analysis was performed and the I2 statistic was used to assess heterogeneity according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Nineteen studies with a total of 2449 patients were included. No differences were identified between the stent retrieval and direct aspiration groups in terms of modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 and mTICI 3 recanalization rates, and favorable outcomes (modified Rankin Scale [mRS] ≤ 2). Adverse event rates, including 90-d mortality, symptomatic intracerebral hemorrhage (sICH), and subarachnoid hemorrhage (SAH), were similar between the stent retrieval and direct aspiration groups. The use of the stent retrieval was associated with a higher risk of vasospasm (odds ratio [OR]: 2.98; 95% confidence interval [CI]: 1.10-8.09; I2: 0%) compared to direct aspiration. When compared with the direct aspiration group, the subgroup of patients who underwent thrombectomy with the combined approach as a first-line strategy had a higher likelihood of successful mTICI 2b/3 (OR: 1.47; 95% CI: 1.02-2.12; I2: 0%) and mTICI 3 recanalization (OR: 3.65; 95% CI: 1.56-8.54), although with a higher risk of SAH (OR: 4.33; 95% CI: 1.15-16.32). CONCLUSION Stent retrieval thrombectomy and direct aspiration did not show significant differences. Current available evidence is not sufficient to draw conclusions on the best surgical approach. The combined use of a stent retriever and aspiration as a first-line strategy was associated with higher mTICI 2b/3 and mTICI 3 recanalization rates, although with a higher risk of 24-h SAH, when compared with direct aspiration.

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Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-analysis of Stent Retrievers Versus Direct Aspiration Versus a Combined Approach

Neurosurgery ◽

10.1093/neuros/nyz310_166 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Pavlos Texakalidis ◽

Stefanos Giannopoulos ◽

Theofilos Karasavvidis ◽

Leonardo Rangel-Castilla ◽

Dennis J Rivet ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Meta Analysis ◽

Stent Retriever ◽

Combined Approach ◽

First Line ◽

Symptomatic Intracerebral Hemorrhage ◽

Rescue Treatment ◽

Combined Use ◽

Stent Retrievers ◽

Event Rates

Abstract INTRODUCTION Recent randomized control trials (RCTs) established that mechanical thrombectomy is superior to medical therapy for patients with stroke. Stent retriever thrombectomy, direct aspiration and combined use of a stent retriever and aspiration have been alternatively used.The aim of this study was to compare the safety and efficacy profile of the different mechanical thrombectomy strategies. METHODS This study was performed according to the PRISMA guidelines. A random-effects model meta-analysis was conducted. RESULTS In all 21 studies with a total of 3059 patients were included. No differences were identified between the stent retriever and aspiration group in terms of modified thrombolysis in cerebral infarction (mTICI) 2b/3, mTICI 3 recanalization rates and favorable outcome (mRS = 2). Adverse event rates including 90-d mortality, symptomatic intracerebral hemorrhage (sICH), subarachnoid hemorrhage (SAH), parenchymal hematoma, new territory emboli, arterial dissection and perforation were similar between the stent retriever and direct aspiration group. Use of the stent retriever was associated with a higher risk of vasospasm (OR:2.59; 95% CI: 1.00-6.74; I2:0%) compared to direct aspiration. When compared with the direct aspiration group, the subgroup of patients who underwent mechanical thrombectomy with the combined approach as a first-line strategy had a higher likelihood of successful mTICI 2b/3 (OR: 1.76; 95% CI:1.23-2.52; I2: 5.5%) and mTICI 3 recanalization (OR: 2.29; 95% CI: 1.08-4.88; I2: 58%) although with a higher risk of SAH (OR: 4.33; 95% CI: 1.15-16.32; I2: -). In addition, patients who had thrombectomy with the combined approach as a rescue treatment after failure of first-line aspiration were at a significantly higher risk of sICH (OR: 3.49; 95% CI: 1.20-10.19; I2: 21.7%). CONCLUSION Stent retriever thrombectomy and direct aspiration were equally safe and effective. When compared with direct aspiration, the combined use of a stent retriever and aspiration as a first-line strategy was associated with higher mTICI 2b/3 and mTICI 3 recanalization rates although with a higher risk of 24-hr SAH.

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Abstract W P26: Meta-analysis Of Studies Using Solitaire And Trevo Pro Stent Retriever Devices For Mechanical Thromboembolectomy In Acute Cerebral Ischemia

Stroke ◽

10.1161/str.45.suppl_1.wp26 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Vikram Jadhav ◽

Mushtaq H Qureshi ◽

Malik M Adil ◽

Amna Zarar ◽

Nidaullah Mian ◽

...

Keyword(s):

Cerebral Ischemia ◽

Publication Bias ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Analysis Software ◽

Symptomatic Intracerebral Hemorrhage ◽

Acute Cerebral Ischemia ◽

Random Models ◽

Log Odds ◽

Event Rates

Objective: To report rates of recanalization and symptomatic intracerebral hemorrhage (SICH) after mechanical thromboembolectomy using Solitaire and Trevo Pro devices in acute cerebral ischemia using meta-analysis of published studies. Methods: We identified all studies that used Solitaire or Trevo devices for mechanical thromboembolectomy in treatment of acute cerebral ischemia using a search on PubMed and Cochrane libraries, stroke trials database, proceedings of neurology and neurosurgery related conferences, and supplemented by a review of bibliographies of selected publications. Recanalization was assessed using TICI >2a and rates of SICH were recorded. For the meta-analysis, forest plots and statistical analysis including event rates [ER] with 95% confidence intervals [CI] based on both fixed and random models were performed using Comprehensive Meta-Analysis Software. The presence of publication bias was interrogated by funnel plot of Standard Error by log odds ratio. Results: Eighteen studies with Solitaire device and five with Trevo device were identified and included in the meta-analysis. There were a total of 433/505 (85%, ER 0.85 [CI] 0.80-0.88, P<0.001) successful recanalizations with Solitaire device whereas 196/243 (80%, ER 0.80 [CI] 0.74-0.85, P<0.001) successful recanalizations were noted with Trevo device. The incidence of SICH was 45/505 (9%, ER 0.09 [CI] 0.06-0.14, P<0.001) with Solitaire device and 17/243 (6%, ER 0.06 [CI] 0.049-0129, P<0.001) with Trevo device after mechanical thrombectomy. There was no publication bias. Conclusions: Meta-analysis of studies reveals similar rates for recanalization and SICH after mechanical thromboembolectomy using Solitaire or Trevo Pro devices.

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Direct mechanical thrombectomy in tPA-ineligible and -eligible patients versus the bridging approach: a meta-analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013834 ◽

2018 ◽

Vol 11 (1) ◽

pp. 20-27 ◽

Cited By ~ 30

Author(s):

Johannes Kaesmacher ◽

Pasquale Mordasini ◽

Marcel Arnold ◽

Elena López-Cancio ◽

Neus Cerdá ◽

...

Keyword(s):

Selection Bias ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Fatal Outcome ◽

Intravenous Thrombolysis ◽

Functional Independence ◽

Randomized Controlled Clinical Trials ◽

Symptomatic Intracerebral Hemorrhage ◽

Inverse Variance ◽

Meta Analyses

BackgroundWhether pretreatment with intravenous thrombolysis prior to mechanical thrombectomy (IVT+MTE) adds additional benefit over direct mechanical thrombectomy (dMTE) in patients with large vessel occlusions (LVO) is a matter of debate.MethodsThis study-level meta-analysis was presented in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled effect sizes were calculated using the inverse variance heterogeneity model and displayed as summary Odds Ratio (sOR) and corresponding 95% confidence interval (95% CI). Sensitivity analysis was performed by distinguishing between studies including dMTE patients eligible for IVT (IVT-E) or ineligible for IVT (IVT-IN). Primary outcome measures were functional independence (modified Rankin Scale≤2) and mortality at day 90, successful reperfusion, and symptomatic intracerebral hemorrhage.ResultsTwenty studies, incorporating 5279 patients, were included. There was no evidence that rates of successful reperfusion differed in dMTE and IVT+MTE patients (sOR 0.93, 95% CI 0.68 to 1.28). In studies including IVT-IN dMTE patients, patients undergoing dMTE tended to have lower rates of functional independence and had higher odds for a fatal outcome as compared with IVT+MTE patients (sOR 0.78, 95% CI 0.61 to 1.01 and sOR 1.45, 95% CI 1.22 to 1.73). However, no such treatment group effect was found when analyses were confined to cohorts with a lower risk of selection bias (including IVT-E dMTE patients).ConclusionThe quality of evidence regarding the relative merits of IVT+MTE versus dMTE is low. When considering studies with lower selection bias, the data suggest that dMTE may offer comparable safety and efficacy as compared with IVT+MTE. The conduct of randomized-controlled clinical trials seems justified.

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SOFIA catheter for direct aspiration of large vessel occlusion stroke: A single-center cohort and meta-analysis

Interventional Neuroradiology ◽

10.1177/15910199211005328 ◽

2021 ◽

pp. 159101992110053

Author(s):

Federico Bolognini ◽

Pablo A Lebedinsky ◽

Mariano Musacchio ◽

Mariette Delaitre ◽

Abdoulaye M Traoré ◽

...

Keyword(s):

Rescue Therapy ◽

Meta Analysis ◽

Functional Independence ◽

Large Vessel ◽

Study Cohort ◽

Large Vessel Occlusion ◽

First Line ◽

Vessel Occlusion ◽

Global Rate ◽

Symptomatic Intracranial Hemorrhage

Background and Purpose Direct aspiration (DA) using large-bore distal aspiration catheters is an established strategy for the endovascular thrombectomy (EVT) of large-vessel occlusion stroke (LVOS). However, the performance of individual catheters like SOFIA has yet to be examined. Methods We present a cohort of 144 consecutive patients treated with first-line DA and SOFIA 6 F Plus catheter for LVOS. We also conducted a systematic review of the literature searching multiple databases for reports on thrombectomy with DA and SOFIA catheters and performed a meta-analysis of recanalization, safety, and clinical outcomes. Results In the study cohort a successful recanalization (mTICI 2b-3) rate of 75.7% was achieved with DA alone, the global rate for functional independence (90-day mRS 0-2) was 40.3%. For the metanalysis we selected nine articles that included a total of 758 patients treated with first-line thrombectomy with the SOFIA catheters. The mTICI 2b-3 rate was 71.6% (95%CI, 66.3-76.5%) while a rescue stent-retriever was used in 24.1% (95%CI, 17.7-31.9%) of cases. The overall mTICI2b-3 rate after DA and rescue therapy was 88.9% (95%CI, 82.6-93.1%). We found a pooled estimate of 45.6% (95%CI, 38.6-52.8%) for functional independence, a mortality within 90 days of 19% (95%CI, 14.1-25.0%) and a rate of 5.8% (95%CI, 4.2-8.0%) of symptomatic intracranial hemorrhage. Conclusion The DA approach for LVOS with the SOFIA catheters is highly effective with an efficacy and safety profile comparable to those found in contemporary thrombectomy trials and observational studies that use other devices or approaches.

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Is a picture-perfect thrombectomy necessary in acute ischemic stroke?

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-017193 ◽

2021 ◽

pp. neurintsurg-2020-017193

Author(s):

Ching-Jen Chen ◽

Reda Chalhoub ◽

Dale Ding ◽

Jeyan S Kumar ◽

Natasha Ironside ◽

...

Keyword(s):

Primary Outcome ◽

Mechanical Thrombectomy ◽

National Institutes Of Health ◽

Stroke Patients ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Symptomatic Intracerebral Hemorrhage ◽

History Of ◽

Multivariable Models ◽

Secondary Outcomes

BackgroundThe benefit of complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 3) over near-complete reperfusion (≥90%, mTICI 2c) remains unclear. The goal of this study is to compare clinical outcomes between mechanical thrombectomy (MT)-treated stroke patients with mTICI 2c versus 3.MethodsThis is a retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) comprising 33 centers. Adults with anterior circulation arterial vessel occlusion who underwent MT yielding mTICI 2c or mTICI 3 reperfusion were included. Patients were categorized based on reperfusion grade achieved. Primary outcome was modified Rankin Scale (mRS) 0–2 at 90 days. Secondary outcomes were mRS scores at discharge and 90 days, National Institutes of Health Stroke Scale score at discharge, procedure-related complications, and symptomatic intracerebral hemorrhage.ResultsThe unmatched mTICI 2c and mTICI 3 cohorts comprised 519 and 1923 patients, respectively. There was no difference in primary (42.4% vs 45.1%; p=0.264) or secondary outcomes between the unmatched cohorts. Reperfusion status (mTICI 2c vs 3) was also not predictive of the primary outcome in non-imputed and imputed multivariable models. The matched cohorts each comprised 191 patients. Primary (39.8% vs 47.6%; p=0.122) and secondary outcomes were also similar between the matched cohorts, except the 90-day mRS which was lower in the matched mTICI 3 cohort (p=0.049). There were increased odds of the primary outcome with mTICI 3 in patients with baseline mRS ≥2 (36% vs 7.7%; p=0.011; pinteraction=0.014) and a history of stroke (42.3% vs 15.4%; p=0.027; pinteraction=0.041).ConclusionsComplete and near-complete reperfusion after MT appear to confer comparable outcomes in patients with acute stroke.

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Stroke thrombectomy complication management

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017349 ◽

2021 ◽

pp. neurintsurg-2021-017349

Author(s):

Sara M Pilgram-Pastor ◽

Eike I Piechowiak ◽

Tomas Dobrocky ◽

Johannes Kaesmacher ◽

Juergen Den Hollander ◽

...

Keyword(s):

Treatment Efficacy ◽

Mechanical Thrombectomy ◽

Complication Management ◽

Line Treatment ◽

Large Vessel Occlusion ◽

First Line ◽

Invasive Treatment ◽

Vessel Occlusion ◽

Endovascular Mechanical Thrombectomy ◽

First Line Treatment

Endovascular mechanical thrombectomy (EVT) is widely accepted as the first-line treatment for acute ischemic stroke in patients with large vessel occlusion. Being an invasive treatment, this method is associated with various preoperative, perioperative, and postoperative complications. These complications may influence peri-interventional morbidity and mortality and therefore treatment efficacy and clinical outcome. The aim of this review is to discuss the most common types of complications associated with EVT, the probable mechanisms of injury, and effective methods to manage and prevent complications.

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Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy—A Clinical and Biomechanical Perspective

Life ◽

10.3390/life11070658 ◽

2021 ◽

Vol 11 (7) ◽

pp. 658

Author(s):

Piotr Piasecki ◽

Marek Wierzbicki ◽

Piotr Tulik ◽

Katarzyna Potocka ◽

Adam Stępień ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Clinical Course ◽

Phantom Study ◽

Stent Retriever ◽

Vessel Occlusion ◽

Intracranial Vessel ◽

Mechanical Study ◽

Stent Retrievers ◽

Phantom Studies ◽

Stroke Centre

Background: The inadvertent detachment of stent retrievers during mechanical thrombectomy is an extremely rare but feared complication associated with poor clinical outcomes. We discuss management considerations after an unexpected disconnection of the pRESET stent retriever during mechanical thrombectomy, based on clinical experience and mechanical and phantom studies. Methods: We present a clinical course of rare accidents of stent-retriever separation inside an intracranial vessel that occurred in patients in a comprehensive stroke centre between 2018 and 2020. We designed a phantom study to assess the Tigertriever’s ability to remove a detached stent retriever from intercranial vessels. In the mechanical study, several types of stent retrievers were evaluated in order to find the weakest point at which detachment occurred. Results: Two patients (~0.7%) with inadvertent stent-retriever detachment were found in our database. Failed attempts of endovascular removal with no recanalization at the end of procedure were reported in both cases. mRS after 3 months was three and four respectively. In the mechanical study, the Tigertriever was the most resistant to detachment and was followed by Embotrap > pRESET > 3D Separator. In the phantom study, the pRESET device detached in a configuration resembling the M1 segment was successfully removed with the Tigertriever. Conclusions: Conservative management of the inadvertent detachment of stent retrievers during mechanical thrombectomy in large vessel occlusion may be acceptable in order to avoid further periprocedural complications after unsuccessful device removal attempts. Based on the phantom and mechanical studies, the Tigertriever may be a useful tool for the removal of detached pRESET devices.

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Predictive Factors for the Need of Tracheostomy in Patients With Large Vessel Occlusion Stroke Being Treated With Mechanical Thrombectomy

Frontiers in Neurology ◽

10.3389/fneur.2021.728624 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ilko L. Maier ◽

Katarina Schramm ◽

Mathias Bähr ◽

Daniel Behme ◽

Marios-Nikos Psychogios ◽

...

Keyword(s):

Logistic Regression ◽

Length Of Stay ◽

Mechanical Thrombectomy ◽

Multivariate Logistic Regression Analysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Icu Stay ◽

Icu Length Of Stay ◽

Symptomatic Intracerebral Hemorrhage

Background: Patients with large vessel occlusion stroke (LVOS) eligible for mechanical thrombectomy (MT) are at risk for stroke- and non-stroke-related complications resulting in the need for tracheostomy (TS). Risk factors for TS have not yet been systematically investigated in this subgroup of stroke patients.Methods: Prospectively derived data from patients with LVOS and MT being treated in a large, academic neurological ICU (neuro-ICU) between 2014 and 2019 were analyzed in this single-center study. Predictive value of peri- and post-interventional factors, stroke imaging, and pre-stroke medical history were investigated for their potential to predict tracheostomy during ICU stay using logistic regression models.Results: From 635 LVOS-patients treated with MT, 40 (6.3%) underwent tracheostomy during their neuro-ICU stay. Patients receiving tracheostomy were younger [71 (62–75) vs. 77 (66–83), p < 0.001], had a higher National Institute of Health Stroke Scale (NIHSS) at baseline [18 (15–20) vs. 15 (10–19), p = 0.009] as well as higher rates of hospital acquired pneumonia (HAP) [39 (97.5%) vs. 224 (37.6%), p < 0.001], failed extubation [15 (37.5%) vs. 19 (3.2%), p < 0.001], sepsis [11 (27.5%) vs. 16 (2.7%), p < 0.001], symptomatic intracerebral hemorrhage [5 (12.5%) vs. 22 (3.9%), p = 0.026] and decompressive hemicraniectomy (DH) [19 (51.4%) vs. 21 (3.8%), p < 0.001]. In multivariate logistic regression analysis, HAP (OR 21.26 (CI 2.76–163.56), p = 0.003], Sepsis [OR 5.39 (1.71–16.91), p = 0.004], failed extubation [OR 8.41 (3.09–22.93), p < 0.001] and DH [OR 9.94 (3.92–25.21), p < 0.001] remained as strongest predictors for TS. Patients with longer periods from admission to TS had longer ICU length of stay (r = 0.384, p = 0.03). There was no association between the time from admission to TS and clinical outcome (NIHSS at discharge: r = 0.125, p = 0.461; mRS at 90 days: r = −0.179, p = 0.403).Conclusions: Patients with LVOS undergoing MT are at high risk to require TS if extubation after the intervention fails, DH is needed, and severe infectious complications occur in the acute phase after ischemic stroke. These factors are likely to be useful for the indication and timing of TS to reduce overall sedation and shorten ICU length of stay.

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Influence of glucose levels on clinical outcome after mechanical thrombectomy for large-vessel occlusion: a systematic review and meta-analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017771 ◽

2021 ◽

pp. neurintsurg-2021-017771

Author(s):

Carlos Perez-Vega ◽

Ricardo A Domingo ◽

Shashwat Tripathi ◽

Andres Ramos-Fresnedo ◽

Samir Kashyap ◽

...

Keyword(s):

Blood Glucose ◽

Clinical Outcome ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

High Blood Glucose ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Increased Risk

Mechanical thrombectomy (MT) represents the mainstay of treatment for patients with acute ischemic stroke due to large-vessel occlusion (LVO). Intravenous thrombolysis has been associated with worse clinical outcome in patients presenting with high blood glucose levels at admission; to date the true effect of hyperglycemia in the setting of MT has not been fully elucidated. In this meta-analysis, we analyzed the influence of high blood glucose levels at admission on clinical outcome after MT. Ovid EMBASE, PubMed, Scopus, and Cochrane Library databases were searched from their dates of inception up to March 2021. An initial search identified 2118 articles representing 1235 unique studies. After applying selection criteria, three prospective and five retrospective studies were analyzed, yielding a pooled cohort of 5861 patients (2041 who presented with hyperglycemia, and 3820 who presented with normal blood glucose levels). Patients in the hyperglycemia group were less likely to have a modified Ranking Scale (mRS) score <3 (risk ratio (RR): 0.65; 95% CI 0.59 to 0.72; p<0.0001; I2=13%), and had an increased risk of symptomatic intracranial hemorrhage (sICH) (RR: 2.07; 95% CI 1.65 to 2.60; p<0.0001; I2=0%) and mortality (RR: 1.73; 95% CI 1.57 to 1.91; p<0.0001; I2=0%). Patients who present with hyperglycemia and undergo MT for treatment of LVO have an increased risk of unfavorable clinical outcome, sICH, and mortality. Glucose levels at admission appear to be a prognostic factor in this subset of patients. Further studies should focus on evaluating control of the glucose level at admission as a modifiable risk factor in patients undergoing MT for LVO.

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Abstract P101: Mechanical Thrombectomy in COVID-19 Positive Patients With Large Vessel Occlusion: Pooled Review of Individual Case Series

Stroke ◽

10.1161/str.52.suppl_1.p101 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Muhammad Z Memon ◽

Taha Nisar ◽

Amit Singla ◽

Anil Nanda ◽

Gaurav Gupta ◽

...

Keyword(s):

Clinical Outcomes ◽

Mechanical Thrombectomy ◽

Case Reports ◽

Case Series ◽

Individual Case ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Historic Data ◽

Meta Analyses

Background: COVID-19 has been shown to induce a hypercoagulable state thereby increasing the risk of arterial thrombosis resulting in Large Vessel Occlusion Stroke (LVOs) Objective: We performed a systematic review of published reports to study the clinical characteristics, and outcomes of COVID-19 acute ischemic stroke (AIS) patients with LVO treated with mechanical thrombectomy (MT) and compared them with historical controls. Methods: We conducted a systematic literature search from December 2019 to July 2020 using multiple combinations of keywords from PubMed and Ovid databases according to the PRISMA meta-analyses and systemic reviews guidelines and then pooled data from individual case series. We included studies where COVID -19 associated LVO cases were treated with MT and their clinical outcomes were reported. We then compared these findings with the historic patient data from the five landmark randomized MT trials, the Hermes collaborators (HC). Results: An initial search generated 12 studies but after excluding case reports and multiple reports comprising of the same series of patients, a total of five reports consisting of 51 patients were analyzed. The mean age of patients was 59 years (IQR 36-75), and 40 (78 %) were men. Median NIHSS on presentation was 20 (IQR 10-29). AIS with LVO was the presenting manifestation of COVID-19 in 16 (20%) of patients. Intracranial ICA was the most common site of occlusion found in 27 (53%) of patients with multi-territory occlusion in 10 (20 %). Final recanalization TICI ≥ 2b was achieved in 33 (64%) of patients but reocclusion was noted in 7 (14 %). Modified Rankin score (mRS) 0-2 was reported in 12 (23 %) of patients with 40 % in-hospital mortality. When compared to historic data from HC, COVID -19 patients were younger (59 vs 69 years), presented with a higher median NIHSS score (20 vs 17), and had a higher prevalence of ICA terminus occlusion (53% vs 21% ). Similarly, patient outcomes were poor in the COVID -19 group with mRs 0-2 in (23 % versus 46 %) and mortality (40 % vs 15 %) compared to Hermes group. Conclusion: COVID -19 AIS patients with LVO who underwent MT were younger, had multiple territory occlusions with a propensity for ICA terminus location, and had poor angiographic and clinical outcomes as compared to historic data.

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