Early Brain Imaging Shows Increased Severity of Acute Ischemic Strokes With Large Vessel Occlusion in COVID-19 Patients
Simon Escalard 1, Vanessa Chalumeau 2, Clément Escalard 3, Hocine Redjem 1, François Delvoye 1, Solène Hébert 1, Stanislas Smajda 1, Gabriele Ciccio 1, Jean-Philippe Desilles 1, Mikael Mazighi 1, Raphael Blanc 1, Benjamin Maïer 1, Michel Piotin 1Affiliations expand
- PMID: 32813602
- PMCID: PMC7446979
- DOI: 10.1161/STROKEAHA.120.031011
Free PMC article
Abstract
Background and purpose: Reports are emerging regarding the association of acute ischemic strokes with large vessel occlusion and coronavirus disease 2019 (COVID-19). While a higher severity of these patients could be expected from the addition of both respiratory and neurological injury, COVID-19 patients with strokes can present with mild or none respiratory symptoms. We aimed to compare anterior circulation large vessel occlusion strokes severity between patients with and without COVID-19.
Methods: We performed a comparative cohort study between patients with COVID-19 who had anterior circulation large vessel occlusion and early brain imaging within 3 hours from onset, in our institution during the 6 first weeks of the COVID-19 outbreak and a control group admitted during the same calendar period in 2019.
Results: Twelve COVID-19 patients with anterior circulation large vessel occlusion and early brain imaging were included during the study period and compared with 34 control patients with anterior circulation large vessel occlusion and early brain imaging in 2019. Patients in the COVID-19 group were younger (P=0.032) and had a history of diabetes mellitus more frequently (P=0.039). Patients did not significantly differ on initial National Institutes of Health Stroke Scale nor time from onset to imaging (P=0.18 and P=0.6, respectively). Patients with COVID-19 had more severe strokes than patients without COVID-19, with a significantly lower clot burden score (median: 6.5 versus 8, P=0.016), higher rate of multivessel occlusion (50% versus 8.8%, P=0.005), lower DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early CT Scores; median: 5 versus 8, P=0.006), and higher infarct core volume (median: 58 versus 6 mL, P=0.004). Successful recanalization rate was similar in both groups (P=0.767). In-hospital mortality was higher in the COVID-19 patients’ group (41.7% versus 11.8%, P=0.025).
Conclusions: Early brain imaging showed higher severity large vessel occlusion strokes in patients with COVID-19. Given the massive number of infected patients, concerns should be raised about the coming neurovascular impact of the pandemic worldwide.
Keywords: brain; coronavirus; ischemia; prognosis; stroke.
Figures
Similar articles
- Mechanical Thrombectomy of COVID-19 positive acute ischemic stroke patient: a case report and call for preparedness.Mansour OY, Malik AM, Linfante I.BMC Neurol. 2020 Sep 24;20(1):358. doi: 10.1186/s12883-020-01930-x.PMID: 32972381 Free PMC article.
- Treatment of Acute Ischemic Stroke due to Large Vessel Occlusion With COVID-19: Experience From Paris.Escalard S, Maïer B, Redjem H, Delvoye F, Hébert S, Smajda S, Ciccio G, Desilles JP, Mazighi M, Blanc R, Piotin M.Stroke. 2020 Aug;51(8):2540-2543. doi: 10.1161/STROKEAHA.120.030574. Epub 2020 May 29.PMID: 32466736 Free PMC article.
- Use of Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) and Ischemic Core Volume to Determine the Malignant Profile in Acute Stroke.Yoshimoto T, Inoue M, Yamagami H, Fujita K, Tanaka K, Ando D, Sonoda K, Kamogawa N, Koga M, Ihara M, Toyoda K.J Am Heart Assoc. 2019 Nov 19;8(22):e012558. doi: 10.1161/JAHA.119.012558. Epub 2019 Nov 8.PMID: 31698986 Free PMC article.
- COVID-19 as a Blood Clotting Disorder Masquerading as a Respiratory Illness: A Cerebrovascular Perspective and Therapeutic Implications for Stroke Thrombectomy.Janardhan V, Janardhan V, Kalousek V.J Neuroimaging. 2020 Sep;30(5):555-561. doi: 10.1111/jon.12770. Epub 2020 Aug 18.PMID: 32776617 Free PMC article. Review.
- Malignant Cerebral Ischemia in A COVID-19 Infected Patient: Case Review and Histopathological Findings.Patel SD, Kollar R, Troy P, Song X, Khaled M, Parra A, Pervez M.J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105231. doi: 10.1016/j.jstrokecerebrovasdis.2020.105231. Epub 2020 Aug 5.PMID: 33066910 Free PMC article. Review.
Cited by 4 articles
- Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19).Harapan BN, Yoo HJ.J Neurol. 2021 Jan 23:1-13. doi: 10.1007/s00415-021-10406-y. Online ahead of print.PMID: 33486564 Free PMC article. Review.
- COVID-19 and cerebrovascular diseases: a comprehensive overview.Tsivgoulis G, Palaiodimou L, Zand R, Lioutas VA, Krogias C, Katsanos AH, Shoamanesh A, Sharma VK, Shahjouei S, Baracchini C, Vlachopoulos C, Gournellis R, Sfikakis PP, Sandset EC, Alexandrov AV, Tsiodras S.Ther Adv Neurol Disord. 2020 Dec 8;13:1756286420978004. doi: 10.1177/1756286420978004. eCollection 2020.PMID: 33343709 Free PMC article. Review.
- Questions and Answers on Practical Thrombotic Issues in SARS-CoV-2 Infection: A Guidance Document from the Italian Working Group on Atherosclerosis, Thrombosis and Vascular Biology.Patti G, Lio V, Cavallari I, Gragnano F, Riva L, Calabrò P, Di Pasquale G, Pengo V, Rubboli A; Italian Study Group on Atherosclerosis, Thrombosis, Vascular Biology.Am J Cardiovasc Drugs. 2020 Dec;20(6):559-570. doi: 10.1007/s40256-020-00446-6. Epub 2020 Nov 3.PMID: 33145698 Free PMC article. Review.
- Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go?Dula AN, Gealogo Brown G, Aggarwal A, Clark KL.JMIR Aging. 2020 Oct 21;3(2):e21608. doi: 10.2196/21608.PMID: 33006936 Free PMC article.
