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Background This study evaluates the mortality risk of patients with emergent large vessel occlusion (ELVO) and COVID-19 during the pandemic. Methods We performed a retrospective cohort study of two cohorts of consecutive patients with ELVO admitted to a quaternary hospital from March 1 to April 17, 2020. We abstracted data from electronic health records on baseline, biomarker profiles, key time points, quality measures and radiographic data. Results Of 179 patients admitted with ischemic stroke, 36 had ELVO. Patients with COVID-19 and ELVO had a higher risk of mortality during the pandemic versus patients without COVID-19 (OR 16.63, p = 0.004). An age-based sub-analysis showed in-hospital mortality in 60% of COVID-19 positive patients between 61-70 years-old, 66.7% in between 51-60 years-old, 50% in between 41-50 years-old and 33.3% in between 31-40 years old. Patients that presented with pulmonary symptoms at time of stroke presentation had 71.4% mortality rate. 27.3% of COVID-19 patients presenting with ELVO had a good outcome at discharge (mRS 0-2). Patients with a history of cigarette smoking (p = 0.003), elevated d-dimer (p = 0.007), failure to recanalize (p = 0.007), and elevated ferritin levels (p = 0.006) had an increased risk of mortality. Conclusion Patients with COVID-19 and ELVO had a significantly higher risk for mortality compared to COVID-19 negative patients with ELVO. A small percentage of COVID-19 ELVO patients had good outcomes. Age greater than 60 and pulmonary symptoms at presentation have higher risk for mortality. Other risk factors for mortality were a history of cigarette smoking, elevated, failure to recanalize, elevated d-dimer and ferritin levels.

Introduction Heart rate variability (HRV) reflects the activity of the autonomic nervous system (ANS) and can be used as a potential predictor of stress-related cardiovascular diseases. This study aimed to assess whether physical and mental strain during the performance of cerebral endovascular procedure influence time-domain HRV parameters in operating surgeon. Materials and Methods Heart rate (HR) and HRV metrics were measured using a HR sensor chest strap before, during, and after neuroendovascular interventions performed by a single neurosurgeon. Three consecutive data series were reported by recording time domain: before procedure, during and after performing endovascular procedures. HR and HRV parameters were recorded during diagnostic and interventional neuroendovascular procedures. HR and HRV measures were analyzed by procedure type and recording time domain. Results HRV measures of a single endovascular neurosurgeon were recorded during 50 procedures. The median intraprocedural HRV score was the lowest and the median HR was the highest (HRV: 52, HR: 89 bpm) compared to preprocedural (HRV: 59, HR: 70 bpm) and postprocedural cardiovascular measures (HRV: 53, HR: 79, bpm, p Conclusions HRV is a reliable tool to measure cardiovascular and mental stress. Interventional neuro-endovascular procedures seem to negatively impact the cardiovascular measures of neurointerventionalists. Further longitudinal studies utilizing HRV are warranted to address their long-term effects on the mental health of physicians.

Supplemental Digital Content is available in the text., Background and Purpose: We sought to determine if biomarkers of inflammation and coagulation can help define coronavirus disease 2019 (COVID-19)–associated ischemic stroke as a novel acute ischemic stroke (AIS) subtype. Methods: We performed a machine learning cluster analysis of common biomarkers in patients admitted with severe acute respiratory syndrome coronavirus 2 to determine if any were associated with AIS. Findings were validated using aggregate data from 3 large healthcare systems. Results: Clustering grouped 2908 unique patient encounters into 4 unique biomarker phenotypes based on levels of c-reactive protein, D-dimer, lactate dehydrogenase, white blood cell count, and partial thromboplastin time. The most severe cluster phenotype had the highest prevalence of AIS (3.6%, P

BACKGROUND AND PURPOSE: Our hypothesis is that the COVID-19 pandemic led to delayed presentations for patients with acute ischemic stroke. This study evaluates the impact of the coronavirus disease 2019 pandemic on presentation, treatment, and outcomes of patients with emergent large-vessel occlusion using data from a large health system in the Bronx, New York. MATERIALS AND METHODS: We performed a retrospective cohort study of 2 cohorts of consecutive patients with emergent large-vessel occlusion admitted to 3 Montefiore Health System hospitals in the Bronx from January 1 to February 17, 2020, (prepandemic) and March 1 to April 17, 2020 (pandemic). We abstracted data from the electronic health records on presenting biomarker profiles, admission and postprocedural NIHSS scores, time of symptom onset, time of hospital presentation, time of start of the thrombectomy procedure, time of revascularization, presenting ASPECTS, TICI recanalization score, mRS, functional outcomes, and mortality. RESULTS: Of 179 patients admitted with ischemic stroke during the study periods, 80 had emergent large-vessel occlusion, of whom 36 were in the pandemic group. Patients in the pandemic group were younger (66 versus 72 years, P

ObjectiveSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is protean in its manifestations, affecting nearly every organ system. However, nervous system involvement and its effect on disease outcome are poorly characterized. The objective of this study was to determine whether neurologic syndromes are associated with increased risk of inpatient mortality.MethodsA total of 581 hospitalized patients with confirmed SARS-CoV-2 infection, neurologic involvement, and brain imaging were compared to hospitalized non-neurologic patients with coronavirus disease 2019 (COVID-19). Four patterns of neurologic manifestations were identified: acute stroke, new or recrudescent seizures, altered mentation with normal imaging, and neuro-COVID-19 complex. Factors present on admission were analyzed as potential predictors of in-hospital mortality, including sociodemographic variables, preexisting comorbidities, vital signs, laboratory values, and pattern of neurologic manifestations. Significant predictors were incorporated into a disease severity score. Patients with neurologic manifestations were matched with patients of the same age and disease severity to assess the risk of death.ResultsA total of 4,711 patients with confirmed SARS-CoV-2 infection were admitted to one medical system in New York City during a 6-week period. Of these, 581 (12%) had neurologic issues of sufficient concern to warrant neuroimaging. These patients were compared to 1,743 non-neurologic patients with COVID-19 matched for age and disease severity admitted during the same period. Patients with altered mentation (n = 258, p = 0.04, odds ratio [OR] 1.39, confidence interval [CI] 1.04–1.86) or radiologically confirmed stroke (n = 55, p = 0.001, OR 3.1, CI 1.65–5.92) had a higher risk of mortality than age- and severity-matched controls.ConclusionsThe incidence of altered mentation or stroke on admission predicts a modest but significantly higher risk of in-hospital mortality independent of disease severity. While other biomarker factors also predict mortality, measures to identify and treat such patients may be important in reducing overall mortality of COVID-19.

Background and Purpose Mechanical thrombectomy has significantly improved post-ischemic stroke clinical outcomes. However, the post-ischemic stroke mortality rate appears to be unchanged. We reviewed potential risk factors that can be related to mortality in patients who underwent mechanical thrombectomy. Materials and Methods A retrospective review was conducted in acute anterior circulation ischemic stroke patients who underwent mechanical thrombectomy but expired within 90 days in a high volume comprehensive stroke center between January 2017 and January 2020. Pre thrombectomy risk factors evaluated include age, NIHSS, ASPECT score, baseline mRS, occlusion site, and IV tPA administration. Post-thrombectomy risk factors include ASPECT score at 24 hours, TICI score, post-procedural subarachnoid hemorrhage (SAH), hemorrhagic transformation, and decompressive craniectomy. Procedural risk factors included the mode of anesthesia, intraprocedural systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP) were reviewed as well as procedural blood pressure variability. The difference between the highest and lowest recorded blood pressure was defined as procedural variability. Results Mechanical thrombectomy was performed in 290 patients, and 54 patients (54/290, 18.6%) were expired at 90 days, which include 42 anterior (77.8%) and 22 posterior circulation patients (22.2%). In 42 anterior circulation acute ischemic stroke patients who expired (M:F=25:17), the mean age was 77.5 ± 13, and 42.86% was at or more than 80 years old. Baseline estimated mRS three or above were seen in 92.7%. The number of days from admission to decease was 7 (median). Pre-procedural ASPECT score >6 was noted in 32 patients (32/42, 76.19%) but in 11 patients (11/42, 26.19%) on post-procedure ASPECT at 24 hours. MCA, ICA and CCA occlusion was found in 69.05%, 19.5%, and 9.52%, respectively. Pre thrombectomy IV tPA was administered in 17 patients (17/42, 40.48%). TICI 2b or three were achieved in 54.7%, with the median number of passes were 2. Ten patients (23.81%) developed post thrombectomy symptomatic intracranial hemorrhages (sICH), and the hemorrhagic transformation was seen in 14.29% (n=6). Three patients (7.14%) received decompressive craniectomy. Mean ‘arrival to groin puncture time’ and ‘groin to reperfusion time’ were 1.13 ± 0.19 hours and 1 hour ± 0.042, respectively. Monitored Anesthesia Care (n=29, 69.04%) was used for most of the procedure. Mean procedural variability of MAP, DBP and SBP were 24.32 + 23.79 mmHg, 16.38 ± 24.83 mmHg, and 40.19 ± 26.83 mmHg, respectively. Conclusion Older age, low baseline estimated mRS, the relatively lower rate of successful reperfusion, the higher rate of sICH, delayed groin to reperfusion time, and higher intraprocedural variability in MAP and DBP were observed in patients with mortality in our study. Disclosures A. Toma: None. A. Vijayashankar: None. N. Haranhalli: None. R. Zampolin: None. D. Altschul: None. A. Brook: None. S. Lee: None.