In Reply: Incidence, Characteristics, and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study

Khandelwal, Priyank; Dmytriw, Adam A; Yavagal, Dileep R.

doi:10.1093/neuros/nyab244

Cited by 5 publications

(12 citation statements)

References 4 publications

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“…17 24 Temuan yang cukup menarik adalah peningkatan persentase stroke iskemik akibat large vessel occlusion (LVO) pada pasien stroke dengan COVID-19, dan cukup banyak ditemukan pada pasien berusia muda (di bawah 50 tahun). 13,14,23,24 Terkait peningkatan frekuensi LVO, Khandelwal P, et al, menyebutkan bahwa rata-rata insidens LVO pada pasien stroke adalah 20-38% di luar konteks COVID-19, namun pada penelitian dari 9 rumah sakit didapatkan insidens LVO sebesar 60% dan beberapa di antaranya terjadi pada usia muda dan semuanya mengalami peningkatan marker inflamasi. 13 Fridman S, et al, mendapati kejadian LVO 2 kali lipat dibanding studi-studi serupa sebelumnya, dengan insidens 46,9% pada semua kelompok umur.…”

Section: Manifestasi Klinisunclassified

“…13,14,23,24 Terkait peningkatan frekuensi LVO, Khandelwal P, et al, menyebutkan bahwa rata-rata insidens LVO pada pasien stroke adalah 20-38% di luar konteks COVID-19, namun pada penelitian dari 9 rumah sakit didapatkan insidens LVO sebesar 60% dan beberapa di antaranya terjadi pada usia muda dan semuanya mengalami peningkatan marker inflamasi. 13 Fridman S, et al, mendapati kejadian LVO 2 kali lipat dibanding studi-studi serupa sebelumnya, dengan insidens 46,9% pada semua kelompok umur. 14 Fraiman, et al, mendapatkan hasil bahwa 105 dari 226 (46,5%) pasien stroke dengan COVID-19 mengalami LVO.…”

Section: Manifestasi Klinisunclassified

“…24 Terkait kejadian stroke pada usia muda, Khandelwal P, et al, menyebutkan bahwa 8 dari 53 total kasus LVO atau sekitar 19% terjadi pada usia di bawah 50 tahun (32 -46 tahun), sejalan dengan Oxley, et al, yang mendapati sejumlah kasus LVO pada pasien COVID-19 yang berusia kurang dari 50 tahun. 13 Fridman S, et al, juga mendapati bahwa sebanyak 29 dari 160 kasus stroke terjadi pada usia di bawah 50 tahun, dan 42,9% di antaranya tidak memiliki faktor risiko ataupun komorbid sebelumnya. Kelompok usia muda ini juga memiliki frekuensi hipertensi paling rendah (20,7%), fibrilasi atrium paling rendah (0%), dan penyakit jantung koroner paling rendah (3,4%), jika dibandingkan dengan kelompok usia lain; peningkatan kadar troponin jantung yang tinggi pada sebagian besar pasien (71,4%) menimbulkan hipotesis keterlibatan kerusakan miokard akut yang mencetuskan stroke, dalam kasus COVID-19 kerusakan yang dimaksud adalah miokarditis.…”

Section: Manifestasi Klinisunclassified

“…27,28 Penelitian-penelitian mendapatkan kecenderungan pasien dengan gejala stroke ringan enggan berobat karena situasi pandemi COVID-19. 13,14,22,23 Khandelwal P, et al, mendapatkan bahwa 17 dari 66 pasien LVO tiba di instalasi gawat darurat sudah dalam keadaan near-complete infarcts yang terlambat untuk trombektomi. Hal ini mendukung hipotesis bahwa pasien dengan gejala stroke ringan dan onset dini mungkin tidak mau pergi ke fasilitas kesehatan karena khawatir terpapar COVID-19.…”

Section: Immune-mediated Brain Injuryunclassified

“…Hal ini mendukung hipotesis bahwa pasien dengan gejala stroke ringan dan onset dini mungkin tidak mau pergi ke fasilitas kesehatan karena khawatir terpapar COVID-19. 13 Penelitian Fridman S, et al, mendukung hipotesis bahwa beberapa pasien dengan gejala stroke ringan memilih untuk di rumah saja pada era pandemi COVID-19; hanya 3 dari 11 pasien muda dengan LVO yang eligible untuk menjalani trombektomi mekanik. 14 Srivastava PK, et al, dan Perry S, et al, menyebutkan bahwa meningkatnya kejadian stroke derajat berat adalah karena pasien COVID-19 dengan gejala stroke ringan mungkin tidak melaporkan kondisinya dan memilih berdiam diri di rumah karena pandemi.…”

Section: Immune-mediated Brain Injuryunclassified

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Pengaruh Coronavirus Disease 2019 (COVID-19) terhadap Insidens dan Tatalaksana Penyakit Serebrovaskular

Hamidjoyo

Wreksoatmodjo

2021

Cermin Dunia Kedokteran

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COVID-19 dikenal dengan manifestasi klinis terkait saluran pernapasan seperti batuk, sesak, dan demam. Namun, saat ini telah banyak diteliti bahwa COVID-19 dapat menimbulkan gejala di luar sistem pernapasan, salah satunya ke sistem saraf. Pelaporan kejadian stroke pada pasien COVID-19 masih bervariasi, namun pada pasien COVID-19, khususnya yang bergejala berat terdapat kondisi hiperkoagulasi yang dapat menyebabkan komplikasi trombotik seperti trombosis vena dalam dan diduga berkaitan dengan risiko stroke pada pasien COVID-19. COVID-19 is known for its clinical manifestations related to the respiratory tract such as cough, shortness of breath, and fever. However, currently it has been widely studied that COVID-19 can cause symptoms outside the respiratory system, one of which is the nervous system. Reports of stroke events in COVID-19 patients still vary, but in COVID-19 patients, especially those with severe symptoms, there is a hypercoagulable condition that can cause thrombotic complications such as deep vein thrombosis and is thought to be associated with the risk of stroke in COVID-19 patients.

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Section: Manifestasi Klinisunclassified

Section: Immune-mediated Brain Injuryunclassified

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Pengaruh Coronavirus Disease 2019 (COVID-19) terhadap Insidens dan Tatalaksana Penyakit Serebrovaskular

Hamidjoyo

Wreksoatmodjo

2021

Cermin Dunia Kedokteran

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The impact of COVID 19 on the outcomes of thrombectomy in stroke patients: A systematic review and meta‐analysis

El‐Qushayri

Reda

Dahy

et al. 2022

Reviews in Medical Virology

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We aimed to conduct the current meta‐analysis to provide better insight into the efficacy of mechanical thrombectomy (MT) in managing COVID‐19 patients suffering from a stroke. An electronic search was conducted through eight databases for collecting the current evidence about the efficacy of MT in stroke patients with COVID‐19 until 18 December 2021. The results were reported as the pooled prevalence rates and the odds ratios (ORs), with their corresponding 95% confidence intervals (CI). Out of 648 records, we included nine studies. The prevalence of stroke patients with COVID‐19 who received MT treatment was with TICI ≥2b 79% (95%CI: 73–85), symptomatic intracranial haemorrhage 6% (95%CI: 3–11), parenchymal haematoma type 1, 11.1% (95%CI: 5–23), and mortality 29% (95%CI: 24–35). On further comparison of MT procedure between stroke patients with COVID 19 to those without COVID‐19, we found no significant difference in terms of TICI ≥2b score (OR: 0.85; 95%CI: 0.03–23; p = 0.9). However, we found that stroke patients with COVID‐19 had a significantly higher mortality rate than stroke patients without COVID‐19 after MT procedure (OR: 2.99; 95%CI: 2.01–4.45; p < 0.001). Stroke patients with COVID‐19 can be safely and effectively treated with MT, with comparable reperfusion and complication rates to those without the disease.

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Letter: Incidence, Characteristics, and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study

Mass-Ramirez¹,

Lozada-Martínez²,

Agrawal³

et al. 2021

Neurosurg.

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To the Editor:We read with great interest the article by Khandelwal et al 1 titled "Incidence, Characteristics, and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study." The authors have meticulously conducted a crosssectional retrospective, multicenter study, to determine the incidence of acute ischemic stroke with large vessel occlusion (LVO) in patients with the coronavirus-19 disease , in 12 centres specialized in the management of neurovascular diseases. It was found that of 6698 patients with COVID-19 admitted to 9 neurovascular care centers, the incidence of stroke was 1.3% (88/6698), and of these, 60% were LVOs. 1 Similarly, the acute LVOs of the 12 centres were analyzed and a total of 66 patients were identified, whose mean age was 51 yr, and of whom 42 underwent treatment with mechanical thrombectomy. This suggests that stroke is a neurological complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, whose pathophysiology may be explained by the state of generalized hypercoagulability and endothelial dysfunction caused by this virus. 1,2 A plethora of scientific literature has been published in the last few months exploring stroke and several links, including mast cells, histiocytes, thrombotic complications, and, but not limited to, neuroinflammation in neurological complications of COVID-19.As with most of the clinical data on COVID-19, the scientific community recognized neurological complications as a recognized marker of severe COVID-19 with a call for action to prevent significant morbidity and mortality. 3,4 We thank Khandelwal et al 1 for providing such valuable evidence; however, we would like to make a few comments. COVID-19 resulting in LVO and stroke in the young population has been predominantly reported as case reports and small series. 5,6 In the present study by Khandelwal et al, 1 16% had LVO under 50 yr of age. This further suggests the validity of existing pathogenic mechanisms of COVID-19 resulting in LVO as stroke in the young population. The authors have included patients with acute ischemic stroke (AIS) with COVID-19 in this study. The findings need to be interpreted with caution as the authors have not mentioned how many of these patients had COVID-19 following the development of AIS and how many had an AIS following the development of COVID-19. Since AIS has been described as a comorbidity with increased risk of adverse events for COVID-19 and vice versa, 3,7,8 it is essential to identify COVID-19 patients complicated by the development of AIS and AIS patients complicated by COVID-19. It has been shown that, during the acute phase of infection, approximately 36% of

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In Reply: Incidence, Characteristics, and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study

Cited by 5 publications

References 4 publications

Pengaruh Coronavirus Disease 2019 (COVID-19) terhadap Insidens dan Tatalaksana Penyakit Serebrovaskular

Pengaruh Coronavirus Disease 2019 (COVID-19) terhadap Insidens dan Tatalaksana Penyakit Serebrovaskular

The impact of COVID 19 on the outcomes of thrombectomy in stroke patients: A systematic review and meta‐analysis

Letter: Incidence, Characteristics, and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study

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