SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group

Abstract

Background. SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investigated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. Methods. This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addition, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). Results. This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6–14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8–40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4–36.2) were associated with cardioembolic stroke. Conclusions. Although a cohort of young and healthy men with cardioembolic and large vessel occlusions can be distinguished using both clinical sub-grouping and unsupervised clustering, stroke in other patients may be explained based on the existing comorbidities.

Vaccine-induced immune thrombotic thrombocytopenia and cerebral venous sinus thrombosis post COVID-19 vaccination; a systematic review

“…The development of vaccines has been shown to be the only effective tool to combat the situation. Vaccines prevent severe illness from SARS-COV-2 infection [ 5 , 6 ]. Thus far, two types of COVID-19 vaccines are developed.…”

Virchow’s Triad and the Role of Thrombosis in COVID-Related Stroke

“…These same risk factors were found in patients with COVID-19 infection that relate to the risk of embolic event during the inflammatory phase of the COVID-19 infection. Another important observation is the evidence of patients with stroke and COVID-19 infection without known comorbidities with an incidence of 22%; these findings suggest a higher incidence of stroke in patients without traditional risk factors ( Shahjouei et al, 2021 ). Further studies are necessary to understand if COVID-19 infection is a trigger for stroke development in patients without know comorbidities or is just a coincidence or an indirect consequence of critical illness ( Walkey et al, 2011 ; Moss et al, 2017 ).…”

Comprehensive Review on Neuro-COVID-19 Pathophysiology and Clinical Consequences

“…As reported previously for other coronavirus infection, increasing evidence unravel the presence of SARS-CoV-2 in multiple CNS loci, concomitant with various neuropathological manifestations. Vascular events counted as one of the most prevalent manifestations of SARS-CoV-2 presence within the CNS (Dmytriw et al 2020;Hamidianjahromi and Mowla 2021;Mowla et al 2020a, b, c;Shahjouei et al 2021Shahjouei et al , 2020Shakibajahromi et al 2020b;Sharifian-Dorche et al 2020;Vahabizad et al 2020). Multiple postmortem anatomical dissections revealed thrombosis and microthrombi (six out of 20 (Bryce et al 2020) and four out of 12 (Meinhardt et al 2020)), concomitant with ischemia and subsequently acute infarctions within the CNS.…”