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Browsing by Author "Alawieh, A"

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  • International Experience of Mechanical Thrombectomy During the COVID-19 Pandemic: Insights from STAR and ENRG
    Publication . Kasab, S; Almallouhi, E; Alawieh, A; Levitt, M; Jabbour, P; Sweid, A; Starke, R; Saini, V; Wolfe, S; Fargen, K; Arthur, A; Goyal, N; Pandhi, A; Fragata, I; Maier, I; Matouk, C; Grossberg, J; Howard, B; Kan, P; Hafeez, M; Schirmer, C; Crowley, R; Joshi, K; Tjoumakaris, S; Chowdry, S; Ares, W; Ogilvy, C; Gomez-Paz, S; Rai, A; Mokin, M; Guerrero, W; Park, M; Mascitelli, J; Yoo, A; Williamson, R; Grande, A; Crosa, R; Webb, S; Psychogios, M; Ducruet, A; Holmstedt, C; Ringer, A; Spiotta, A
    Background: In response to the COVID-19 pandemic, many centers altered stroke triage protocols for the protection of their providers. However, the effect of workflow changes on stroke patients receiving mechanical thrombectomy (MT) has not been systematically studied. Methods: A prospective international study was launched at the initiation of the COVID-19 pandemic. All included centers participated in the Stroke Thrombectomy and Aneurysm Registry (STAR) and Endovascular Neurosurgery Research Group (ENRG). Data was collected during the peak months of the COVID-19 surge at each site. Collected data included patient and disease characteristics. A generalized linear model with logit link function was used to estimate the effect of general anesthesia (GA) on in-hospital mortality and discharge outcome controlling for confounders. Results: 458 patients and 28 centers were included from North America, South America, and Europe. Five centers were in high-COVID burden counties (HCC) in which 9/104 (8.7%) of patients were positive for COVID-19 compared with 4/354 (1.1%) in low-COVID burden counties (LCC) (P<0.001). 241 patients underwent pre-procedure GA. Compared with patients treated awake, GA patients had longer door to reperfusion time (138 vs 100 min, P=<0.001). On multivariate analysis, GA was associated with higher probability of in-hospital mortality (RR 1.871, P=0.029) and lower probability of functional independence at discharge (RR 0.53, P=0.015). Conclusion: We observed a low rate of COVID-19 infection among stroke patients undergoing MT in LCC. Overall, more than half of the patients underwent intubation prior to MT, leading to prolonged door to reperfusion time, higher in-hospital mortality, and lower likelihood of functional independence at discharge.
    2020Journal article Open access Show more
  • Prognostic Significance of Age Within the Adolescent and Young Adult Acute Ischemic Stroke Population after Mechanical Thrombectomy: Insights from STAR
    Publication . Lu, VM; Luther, EM; Silva, MA; Elarjani, T; Abdelsalam, A; Maier, I; Al Kasab, S; Jabbour, PM; Kim, JT; Wolfe, SQ; Rai, AT; Psychogios, MN; Samaniego, EA; Arthur, AS; Yoshimura, S; Grossberg, JA; Alawieh, A; Fragata, I; Polifka, A; Mascitelli, J; Osbun, J; Park, MS; Levitt, MR; Dumont, T; Cuellar, H; Williamson, RW; Romano, DG; Crosa, R; Gory, B; Mokin, M; Moss, M; Limaye, K; Kan, P; Yavagal, DR; Spiotta, AM; Starke, RM
    Objective: Although younger adults have been shown to have better functional outcomes after mechanical thrombectomy (MT) for acute ischemic stroke (AIS), the significance of this relationship in the adolescent and young adult (AYA) population is not well defined given its undefined rarity. Correspondingly, the goal of this study was to determine the prognostic significance of age in this specific demographic following MT for large-vessel occlusions. Methods: A prospectively maintained international multi-institutional database, STAR (Stroke Thrombectomy and Aneurysm Registry), was reviewed for all patients aged 12-18 (adolescent) and 19-25 (young adult) years. Parameters were compared using chi-square and t-test analyses, and associations were interrogated using regression analyses. Results: Of 7192 patients in the registry, 41 (0.6%) satisfied all criteria, with a mean age of 19.7 ± 3.3 years. The majority were male (59%) and young adults (61%) versus adolescents (39%). The median prestroke modified Rankin Scale (mRS) score was 0 (range 0-2). Strokes were most common in the anterior circulation (88%), with the middle cerebral artery being the most common vessel (59%). The mean onset-to-groin puncture and groin puncture-to-reperfusion times were 327 ± 229 and 52 ± 42 minutes, respectively. The mean number of passes was 2.2 ± 1.2, with 61% of the cohort achieving successful reperfusion. There were only 3 (7%) cases of reocclusion. The median mRS score at 90 days was 2 (range 0-6). Between the adolescent and young adult subgroups, the median mRS score at last follow-up was statistically lower in the adolescent subgroup (1 vs 2, p = 0.03), and older age was significantly associated with a higher mRS at 90 days (coefficient 0.33, p < 0.01). Conclusions: Although rare, MT for AIS in the AYA demographic is both safe and effective. Even within this relatively young demographic, age remains significantly associated with improved functional outcomes. The implication of age-dependent stroke outcomes after MT within the AYA demographic needs greater validation to develop effective age-specific protocols for long-term care across both pediatric and adult centers.
    2022Journal article Open access Show more