Descriptive analysis of Acute Ischemic stroke in COVID-19 patients through the course of the COVID-19 pandemic

Liu, Jay Liuhong; Shah, Keval; Marji, Amin; Sareini, Ricky; Bhasin, Amman; Rao, Shishir; Mohamed, Wazim; Rajamani, Kumar; Chamiraju, Parthasarathi; Khawaja, Ayaz

doi:10.1016/j.jocn.2021.10.023

Cited by 4 publications

(3 citation statements)

References 14 publications

(17 reference statements)

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“…The slight variations in RR seem to depend on the “ a priori ” definition of disease severity, but all the studies were consistent in indicating the risk factor effect direction ( 39 ). Time from COVID-19 onset to stroke occurrence varies across studies, from 0 to 19 days ( 40 , 41 ). Jang et al ( 42 ) reported that the first 3 days from COVID-19 onset were the ones with the highest incidence rate ratio (IRR) for acute stroke, 10 times higher than in non-COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

Ischemic strokes in COVID-19: risk factors, obesity paradox, and distinction between trigger and causal association

Janes,

Sozio,

Gigli

et al. 2023

Front. Neurol.

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Background and purposeStroke has been described as a COVID-19 complication. However, its occurrence rate, risk factors, and causal relationships are still not well established.MethodsWe describe the characteristics of confirmed COVID-19-related strokes among all cases of COVID-19 hospitalized in our health network, from November 1, 2020 to April 30, 2021. Risk factor analysis has been conducted for ischemic stroke (IS), which represents 92% of all confirmed cases of Covid-19-related strokes, and a “causal attribution to infection” classification is provided.ResultsIn all, 62/4105 hospitalized COVID-19 patients had an acute stroke (1.51%). Severe COVID-19 (OR 2.27—CI 1.06–4.77; p = 0.032), atrial fibrillation (OR 3.65—CI 1.63–7.98; p = 0.001), and ischemic heart disease (OR 4.590—CI 1.714–12.137; p = 0.002) proved to be independent risk factors for IS, while obesity was a protective factor (OR 0.90—CI 0.82–0.97; p = 0.012). COVID-19 had a causal role in 32.1% of IS cases, was a relevant cofactor in 28.6% of cases of IS, and was a possible trigger in 39.3% of events.ConclusionOur stroke occurrence rate is consistent with other population-based reports (range 0.34–2.7%). Prespecified peculiar clinical and radiological features allow the distinction between “IS caused by COVID-19” and “IS triggered by COVID-19.” Clinical history of vascular diseases and risk factors is crucial in determining the risk of IS in patients with COVID-19. However, the protective effect of a BMI > 30 kg/m2 seems to suggest an obesity paradox.

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Section: Discussionmentioning

confidence: 99%

Ischemic strokes in COVID-19: risk factors, obesity paradox, and distinction between trigger and causal association

Janes,

Sozio,

Gigli

et al. 2023

Front. Neurol.

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“…Previous literature of COVID-19 AIS highlights the difficulty of persistent negative COVID-19 testing despite prototypical symptoms and radiographic findings. 8 The sensitivity of PCR testing has been shown to be 90% within the first five days of symptoms but drops off considerably to 30% sensitivity 21 days after symptom onset, 28 so false negative results are possible with nasopharyngeal swab an inadequate testing modality.…”

Section: Discussionmentioning

confidence: 99%

“…5 This difference has been attributed in part to the observed propensity towards occlusions in multiple vascular territories, intraprocedural embolization to new vascular territories, and intraprocedural reocclusion. 6 Previous case series of patients undergoing mechanical thrombectomy (MT) have demonstrated high rates of re-occlusion [7][8][9] and distal embolization. 10 However, none of these studies reported their treatment of these patients, including their choice of antithrombotic therapies or their approach to repeat MT.…”

Section: Introductionmentioning

confidence: 99%

Dual antiplatelet use in the management of COVID-19 associated acute ischemic stroke reocclusion

et al. 2022

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Intro SARS-CoV-2 (COVID-19) infection is associated with acute ischemic stroke (AIS), which may be due to a prothrombotic state. Early reports have suggested high rates of reocclusion following mechanical thrombectomy (MT) with poor radiographic and clinical outcomes. We report our early experience using intra-procedural antithrombotics to address SARS-CoV-2 reocclusion. Methods We identified 6 patients that experienced early reocclusion after MT for COVID-19-associated AIS through retrospective chart review abstracting their basic demographics, COVID-19 status, and stroke management. All these patients were treated after reocclusion with aspirin and cangrelor intra-procedurally, the latter of which was converted to ticagrelor post-procedurally. Some patients additionally received argatroban infusion intraprocedurally. Results Mean age was 54. There were 3 post-procedural and 3 intra-procedural re-occlusions. After repeat thrombectomy and treatment with aspirin and cangrelor, those with post-procedure reocclusion did not show further reocclusion, while those with intra-procedural reocclusion showed radiographic improvement with intraprocedural cangrelor administration. Outcomes for these patients were poor, with a median mRS of 4. Two patients developed petechial hemorrhage of their stroke which was managed conservatively, and one developed a retroperitoneal hemorrhage from femoral access requiring transfusion. There were no patients who developed new parenchymal hematomas. Conclusion COVID-19 AIS may be associated with a hypercoagulable state which risks malignant reocclusion complicating MT. We found antithrombotic treatment periprocedural cangrelor with or without argatroban transitioned to oral aspirin with ticagrelor to be a viable method for management of these patients.

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Stroke in COVID-19

Gross‐Paju¹,

Kõrv²,

Viigimaa³

2022

Contemporary Cardiology

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Descriptive analysis of Acute Ischemic stroke in COVID-19 patients through the course of the COVID-19 pandemic

Cited by 4 publications

References 14 publications

Ischemic strokes in COVID-19: risk factors, obesity paradox, and distinction between trigger and causal association

Ischemic strokes in COVID-19: risk factors, obesity paradox, and distinction between trigger and causal association

Dual antiplatelet use in the management of COVID-19 associated acute ischemic stroke reocclusion

Stroke in COVID-19

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