SARS-CoV-2 and Stroke Characteristics

Abstract

Background and Purpose: Stroke is reported as a consequence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in several reports. However, data are sparse regarding the details of these patients in a multinational and large scale. Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke, intracranial hemorrhage, and cerebral venous or sinus thrombosis among SARS-CoV-2–infected patients. We further investigated the risk of large vessel occlusion, stroke severity as measured by the National Institutes of Health Stroke Scale, and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with acute ischemic stroke. In addition, we explored the neuroimaging findings, features of patients who were asymptomatic for SARS-CoV-2 infection at stroke onset, and the impact of geographic regions and countries’ health expenditure on outcomes. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least 1 eligible stroke patient. Of 432 patients included, 323 (74.8%) had acute ischemic stroke, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis. A total of 183 (42.4%) patients were women, 104 (24.1%) patients were <55 years of age, and 105 (24.4%) patients had no identifiable vascular risk factors. Among acute ischemic stroke patients, 44.5% (126 of 283 patients) had large vessel occlusion; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median National Institutes of Health Stroke Scale (8 [3–17] versus 11 [5–17]; P =0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; P <0.001) in countries with middle-to-high health expenditure when compared with countries with lower health expenditure. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144 (37.8%) were asymptomatic at the time of admission for SARS-CoV-2 infection. Conclusions: We observed a considerably higher rate of large vessel occlusions, a much lower rate of small vessel occlusion and lacunar infarction, and a considerable number of young stroke when compared with the population studies before the pandemic. The rate of mechanical thrombectomy was significantly lower in countries with lower health expenditures.

Ischemic Stroke and Vaccine-Induced Immune Thrombotic Thrombocytopenia following COVID-19 Vaccine: A Case Report with Systematic Review of the Literature

“…A higher prevalence of LVOs (up to 47%) was also found in stroke patients with SARS-CoV-2 infection, across all age groups, even in the absence of risk factors or comorbidities. Moreover, in young patients prevalence reached up to 68.8% [ 38 , 39 ]. Another unusual feature of ischemic stroke in VITT is the high prevalence of both large intraluminal thrombi and free-floating thrombi in extracranial vessels, such as carotid artery, in the absence of underlying atherosclerotic disease.…”

Epitranscriptome in Ischemic Cardiovascular Disease: Potential Target for Therapies

“…Finally, RNA editing has been also involved in the onset of CVD events, that is, stroke, in the context of coronavirus disease 2019 (COVID-19)/SARS-CoV-2 infection, 35,36 supporting the central role of and need to understand the mechanisms behind RNA editing and its role in inflammation and CVD as future prognosis and treatment tool.…”

SARS-CoV-2 and Acute Cerebrovascular Events: An Overview

“…Stroke patients with COVID-19 infection usually present with a higher National Institutes of Health Stroke Scale (NIHSS) score at admission [ 60 , 63 ], a more severe disease course, immunocompromisation, and with different comorbidities and cardiovascular risk factors [ 53 , 54 ]. The age range is reported to be usually over 50 years old.…”

“…A large multicenter study reported stroke characteristics in 432 COVID-19 patients admitted to 71 centers from 17 countries. They observed a considerably higher rate of large vessel occlusions, a much lower rate of small vessel occlusion and lacunar infarction, and a considerable number of young strokes when compared with the population studies before the pandemic [ 63 ]. More data and studies on the incidence of stroke in young COVID-19 patients are needed.…”