Predictors of mortality for patients with COVID-19 and large vessel occlusion

Altschul, David; Esenwa, Charles; Haranhalli, Neil; Unda, Santiago R.; Ramos, Rafael De la Garza; Dardick, Joseph; Fernandez-Torres, Jenelys; Toma, Aureliana; Labovitz, Daniel L.; Cheng, Natalie; Lee, Seon Kyu; Brook, Allan; Zampolin, Richard L.

doi:10.1177/1591019920954603

Cited by 22 publications

(18 citation statements)

References 8 publications

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“…46,65,67,68,108,110,115 Characteristically, LVO may affect younger patients without known risk factors for stroke, it is associated with higher in-hospital mortality and may represent the initial manifestation leading to hospitalization during SARS-CoV-2 infection. 65,67,115,116 Hypercoagulable state, cardioembolism, or paradoxical embolism due to COVID-19 may be potential reasons for such a stroke presentation. Furthermore, unexpected IS locations, such as in the corpus callosum or a frequent involvement of posterior circulation, have been associated with COVID-19.…”

Section: Red Flags For Covid-19-associated Stroke Diagnosismentioning

confidence: 99%

COVID-19 and cerebrovascular diseases: a comprehensive overview

Tsivgoulis

Palaiodimou

Zand

et al. 2020

Ther Adv Neurol Disord

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Neurological manifestations are not uncommon during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A clear association has been reported between cerebrovascular disease and coronavirus disease 2019 (COVID-19). However, whether this association is causal or incidental is still unknown. In this narrative review, we sought to present the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describe the stroke syndromes and their prognosis and discuss several clinical, radiological, and laboratory characteristics that may aid in the prompt recognition of cerebrovascular disease during COVID-19. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune reaction and inflammation, coagulopathy, COVID-19-associated cardiac injury with subsequent cardio-embolism, complications due to critical illness and prolonged hospitalization can all contribute as potential etiopathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral hemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients with a prevalence ranging between 0.5% and 5%. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients in different cohort studies. Specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ to alarm clinicians in recognizing COVID-19-related stroke.

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Section: Red Flags For Covid-19-associated Stroke Diagnosismentioning

confidence: 99%

COVID-19 and cerebrovascular diseases: a comprehensive overview

Tsivgoulis

Palaiodimou

Zand

et al. 2020

Ther Adv Neurol Disord

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“…Altschul et al found that patients with COVID-19 and emergent large vessel occlusion had a higher risk of mortality during the pandemic vs patients without COVID-19 (OR 16.63 [95% CI, 2.47–112], p = 0.004) and mortality was higher if patients were older than 60 years of age and had pulmonary symptoms. 11 In-hospital mortality was also found to be higher in patients with large vessel occlusion who had COVID-19 vs those without COVID-19 (41.7% vs 11.8%, p = 0.025) by Escalard et al 29 Jain et al found higher mortality risk (OR = 6.02 [95% CI, 2.6–14.6], p < 0.001) in COVID-19 patients with neuroimaging findings, the vast majority of which were ischemic or hemorrhage stroke (92.5%). 15 Ntaios et al was the largest study (174 patients) to report on mortality in large vessel acute ischemic stroke from 16 countries and found patients with COVID-19 had a higher risk of death (OR = 4.3 [95% CI, 2.22–8.30]) compared to matched COVID-19 negative patients.…”

Section: Discussionmentioning

confidence: 99%

Special report of the RSNA COVID-19 task force: systematic review of outcomes associated with COVID-19 neuroimaging findings in hospitalized patients

Mogensen

Wangaryattawanich

Hartman

et al. 2021

BJR

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Objective: We reviewed the literature to describe outcomes associated with abnormal neuroimaging findings among adult COVID-19 patients. Methods: We performed a systematic literature review using PubMed and Embase databases. We included all studies reporting abnormal neuroimaging findings among hospitalized patients with confirmed COVID-19 and outcomes. Data elements including patient demographics, neuroimaging findings, acuity of neurological symptoms and/or imaging findings relative to COVID-19 onset (acute, subacute, chronic), and patient outcomes were recorded and summarized. Results: After review of 775 unique articles, a total of 39 studies comprising 884 COVID-19 patients ≥ 18 years of age with abnormal neuroimaging findings and reported outcomes were included in our analysis. Ischemic stroke was the most common neuroimaging finding reported (49.3%, 436/884) among patients with mortality outcomes data. Patients with intracranial hemorrhage (ICH) had the highest all-cause mortality (49.7%, 71/143), followed by patients with imaging features consistent with leukoencephalopathy (38.5%, 5/13), and ischemic stroke (30%, 131/436). There was no mortality reported among COVID-19 patients with acute disseminated encephalomyelitis without necrosis (0%, 0/8) and leptomeningeal enhancement alone (0%, 0/12). Stroke was a common acute or subacute neuroimaging finding, while leukoencephalopathy was a common chronic finding. Conclusion: Among hospitalized COVID-19 patients with abnormal neuroimaging findings, those with ICH had the highest all-cause mortality; however, high mortality rates were also seen among COVID-19 patients with ischemic stroke in the acute/subacute period and leukoencephalopathy in the chronic period. Advances in knowledge: Specific abnormal neuroimaging findings may portend differential mortality outcomes, providing a potential prognostic marker for hospitalized COVID-19 patients.

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“…Evidence from multiple published studies supports an association between COVID-19 and longer hospital stay, higher complications rates, worse functional outcomes and higher in-hospital mortality rates in AIS/LVO patients—whether they underwent MT or not—when compared with those without the infection. 3 , 16 – 18 , 26 , 35 , 40 , 41 A comprehensive cross-sectional study of patients from a large New York-based health care system found that stroke patients with COVID-19 had over a 9-fold increase in mortality compared with those without the infection. 42 Interestingly, they identified a higher risk of unfavorable outcomes in COVID-19 patients with ischemic stroke independent of traditional stroke risk factors and surrogates of stroke severity, which they attributed to the respiratory impact of COVID-19 on an already compromised patient with stroke.…”

Section: Methodsmentioning

confidence: 99%

Mechanical Thrombectomy Outcomes in COVID-19 Patients With Acute Ischemic Stroke

2021

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Background: Coronavirus disease 2019 (COVID-19) has been shown to associate with increased risk of thromboembolic events. Mechanical thrombectomy (MT) has long been used to effectively manage those with large-vessel occlusive (LVO) stroke and has similarly been implemented in the management of stroke in COVID-19 patients. Review Summary: The COVID-19 pandemic took the health care sector by a storm. Thus, less is known about MT outcomes in this population and evidence suggesting poor outcomes postthrombectomy for COVID-19 patients is accumulating. We provide a narrative on some of the published studies on the outcomes of MT in COVID-19 patients with LVO between March 2020 and February 2021. A description of patient characteristics, risk factors, COVID-19 infection severity, stroke features and thrombectomy success in this population is also presented as data from several studies show that LVO in COVID-19 patients may have some distinguishing characteristics that make management more challenging. Conclusions: The effect of COVID-19 on the long-term prognosis of stroke patients after thrombectomy is yet to be determined. The accumulating evidence from current studies indicates a negative impact of COVID-19 on outcomes in acute ischemic stroke patients who receive MT, irrespective of timely, successful angiographic recanalization. This review may help alert clinicians of some of the COVID-19-specific postthrombectomy challenges.

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Predictors of mortality for patients with COVID-19 and large vessel occlusion

Cited by 22 publications

References 8 publications

COVID-19 and cerebrovascular diseases: a comprehensive overview

COVID-19 and cerebrovascular diseases: a comprehensive overview

Special report of the RSNA COVID-19 task force: systematic review of outcomes associated with COVID-19 neuroimaging findings in hospitalized patients

Mechanical Thrombectomy Outcomes in COVID-19 Patients With Acute Ischemic Stroke

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