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

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%, 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.