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

Abstract

BACKGROUND While there are reports of acute ischemic stroke (AIS) in coronavirus disease 2019 (COVID-19) patients, the overall incidence of AIS and clinical characteristics of large vessel occlusion (LVO) remain unclear. OBJECTIVE To attempt to establish incidence of AIS in COVID-19 patients in an international cohort. METHODS A cross-sectional retrospective, multicenter study of consecutive patients admitted with AIS and COVID-19 was undertaken from March 1 to May 1, 2020 at 12 stroke centers from 4 countries. Out of those 12 centers, 9 centers admitted all types of strokes and data from those were used to calculate the incidence rate of AIS. Three centers exclusively transferred LVO stroke (LVOs) patients and were excluded only for the purposes of calculating the incidence of AIS. Detailed data were collected on consecutive LVOs in hospitalized patients who underwent mechanical thrombectomy (MT) across all 12 centers. RESULTS Out of 6698 COVID-19 patients admitted to 9 stroke centers, the incidence of stroke was found to be 1.3% (interquartile range [IQR] 0.75%-1.7%). The median age of LVOs patients was 51 yr (IQR 50-75 yr), and in the US centers, African Americans comprised 28% of patients. Out of 66 LVOs, 10 patients (16%) were less than 50 yr of age. Among the LVOs eligible for MT, the average time from symptom onset to presentation was 558 min (IQR 82-695 min). A total of 21 (50%) patients were either discharged to home or discharged to acute rehabilitation facilities. CONCLUSION LVO was predominant in patients with AIS and COVID-19 across 2 continents, occurring at a significantly younger age and affecting African Americans disproportionately in the USA.

Three-month functional outcomes following endovascular thrombectomy during the first wave of the COVID-19 pandemic: a Canadian single-center cohort study

“…14 15 We also did not document a decrease in acute stroke evaluation and treatment volumes. [15][16][17][18] These differences likely highlight the local The pandemic and neurointervention heterogeneity of COVID-19 epidemiology and that the impact of the pandemic is likely to differ accordingly. The major strength of our study is the detailed data captured on all consecutive patients evaluated for a possible acute stroke during the study period and the high proportion (approximately 80%) of EVT-treated patients for which 90-day outcomes were documented.…”

Neurological and Head/Eyes/Ears/Nose/Throat Manifestations of COVID-19: A Systematic Review and Meta-Analysis

“…61 This observation was validated by an analysis of 41,971 patients with acute ischemic stroke in the Get With The Guidelines-Stroke database, which found that patients with COVID-19 were more likely to have LVOs and more severe stroke, in addition to being younger. 62 The Black population seems to be disproportionately represented among patients with COVID-associated stroke in the United States; 62,63 this community has also been disproportionately affected by the pandemic on all fronts. Whilst few studies have reported the underlying etiologies of stroke in the setting of COVID-19 in any detail, two studies have suggested that cryptogenic etiologies may be more common in patients with ischemic stroke in the context of COVID-19 compared to stroke without COVID-19.…”

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

“…We thank authors 1 for their interest in our work, 2 and for raising important points about the etiopathogenesis of acute ischemic stroke (AIS) in COVID-19.…”