Emergent Large Vessel Occlusion Stroke During New York City’s COVID-19 Outbreak

Abstract

Background and Purpose: The 2019 novel coronavirus outbreak and its associated disease (coronavirus disease 2019 [COVID-19]) have created a worldwide pandemic. Early data suggest higher rate of ischemic stroke in severe COVID-19 infection. We evaluated whether a relationship exists between emergent large vessel occlusion (ELVO) and the ongoing COVID-19 outbreak. Methods: This is a retrospective, observational case series. Data were collected from all patients who presented with ELVO to the Mount Sinai Health System Hospitals across New York City during the peak 3 weeks of hospitalization and death from COVID-19. Patients’ demographic, comorbid conditions, cardiovascular risk factors, COVID-19 disease status, and clinical presentation were extracted from the electronic medical record. Comparison was made between COVID-19 positive and negative cohorts. The incidence of ELVO stroke was compared with the pre-COVID period. Results: Forty-five consecutive ELVO patients presented during the observation period. Fifty-three percent of patients tested positive for COVID-19. Total patients’ mean (±SD) age was 66 (±17). Patients with COVID-19 were significantly younger than patients without COVID-19, 59±13 versus 74±17 (odds ratio [95% CI], 0.94 [0.81–0.98]; P =0.004). Seventy-five percent of patients with COVID-19 were male compared with 43% of patients without COVID-19 (odds ratio [95% CI], 3.99 [1.12–14.17]; P =0.032). Patients with COVID-19 were less likely to be White (8% versus 38% [odds ratio (95% CI), 0.15 (0.04–0.81); P =0.027]). In comparison to a similar time duration before the COVID-19 outbreak, a 2-fold increase in the total number of ELVO was observed (estimate: 0.78 [95% CI, 0.47–1.08], P ≤0.0001). Conclusions: More than half of the ELVO stroke patients during the peak time of the New York City’s COVID-19 outbreak were COVID-19 positive, and those patients with COVID-19 were younger, more likely to be male, and less likely to be White. Our findings also suggest an increase in the incidence of ELVO stroke during the peak of the COVID-19 outbreak.

Ischemic stroke in COVID-19-positive patients: an overview of SARS-CoV-2 and thrombotic mechanisms for the neurointerventionalist

“…1 2 5 29 38 Among COVID-19-positive patients in New York presenting with emergent LVO, more than 90% had elevated D-dimer levels and 42% presented with symptoms of acute ischemic stroke rather than typical respiratory symptoms. 29 In addition, patients presented with stroke days before demonstrating symptoms of COVID-19, suggesting that there may be an increased risk of thrombosis even in the early phase of the disease. 5 39 A recent review found a consistent increase in D-dimer levels among patients with severe compared with non-severe COVID-19 disease.…”

In Reply: Dismantling the Apocalypse Narrative: The Myth of the COVID-19 Stroke

“…Even the data presented in table 1 showed that the numbers of LVOs quadrupled at their hospital. 25 , 48 In fact, the reduction in telestroke consults and total stroke admission started before releasing the 2 publications. 2 , 23 Patients were delaying presentation to the hospitals due to fear of the contagion.…”

“…In fact, the Fire Department of the City of New York reported an almost 4-times normal rate of patients being dead on emergency medical service arrival during the pandemic period. 48 The authors appear to be confusing the quarantine effect on stroke broadly (which has also been well documented) in the literature with the actual scientific pathophysiology of the disease. 49 , 50 COVID-19 is been overwhelmingly demonstrated to be pro-thrombotic and causes clots to form in a wide range of organ systems… whether fractures in systems of care, changed referral patterns, ED resource re-allocation, social distancing, or self-isolation result in decreased stroke presentation to hospitals, the pro-thrombotic reality of COVID-19 is scientifically unarguable.…”

“…There are now multiple publications from many different geographies that all demonstrate COVID-19 positive ELVO populations are statistically younger than non-COVID-19 populations. 20 , 21 , 41 , 48 , 51…”

“…Furthermore, statistically significant differences in traditional stroke risk factors have been well demonstrated between COVID-19 ELVO patients and non-COVID-19 ELVO patients. 48 …”