Acute Ischemic Stroke and COVID-19: Experience From a Comprehensive Stroke Center in Midwest US

Abstract

Background: COVID-19 has been associated with increased risk of venous and arterial thromboembolism including ischemic stroke. We report on patients with acute ischemic stroke and concomitant COVID-19 in a diverse patient population. Methods: This is a retrospective analysis of patients hospitalized with acute ischemic stroke (AIS) and COVID-19 to our comprehensive stroke center in Chicago, IL, between March 1, 2020, and April 30, 2020. We reviewed stroke characteristics, etiologies, and composite outcomes. We then compared our cohort with historic patients with AIS without COVID-19 admitted in the same time frame in 2019 and 2020. Results: Out of 13 patients with AIS and COVID-19, Latinos and African-Americans compromised the majority of our cohort (76.8%), with age ranging from 31-80 years. Most strokes were cortical (84.6%) and more than 50% of patients had no identifiable source, and were categorized as embolic stroke of unknown source (ESUS). A trend toward less alteplase administration was noted in the COVID-19 stroke patients compared to the non-COVID group from 2020 and 2019 (7.1 vs. 20.7% p 0.435 and 7.1 vs. 27.2% p 0.178). Endovascular thrombectomy was performed in 3 (23%) patients. Systemic thrombotic complications occurred in 3 (23%) COVID-19 AIS patients. Median National Institutes of Health Stroke Scale and modified Rankin Scale at discharge were 11 (IQR 4-23) and 4 (IQR 3-4), respectively. In the logistic regression model corrected for age and sex, COVID-19 was associated with discharge to mRS > 2 (p 0.046, OR 3.82, CI 1.02-14.3). Eight patients (63.8%) were discharged home or to acute rehabilitation, and two deceased from COVID-19 complications. Conclusion: AIS in the setting of COVID-19 is associated with worse outcomes, especially among African-American and Latino populations. Large vessel disease with ESUS was common suggesting an increased risk of coagulopathy and endothelial dysfunction as a potential etiology.

Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry

“…However, we did not centrally adjudicate vascular, echocardiographic, or parenchymal imaging in order to confirm the diagnosis of cryptogenic infarction. Our determination of cryptogenic stroke is congruent with many published reports which did not report a detailed methodology for determination of cryptogenic mechanism, [ 22 ] did not require intracranial vascular imaging, [ 23 ] or included patients for whom workup could not be completed [ 20 ]. Therefore, we do not believe the clinical determination of cryptogenic stroke to be a significant limitation of this analysis.…”

“…Furthermore, the higher mortality rate observed in patients with cryptogenic stroke speaks to the severity of COVID-19 experienced by these patients. On the other hand, diagnostic workup for patients in this study (and in other studies) [ 20 , 22 , 23 ] may not have been completed for some patients with COVID-19 in whom care was being withdrawn or who expired soon before workup could have been completed. This might have confounded our observation of a high rate of cryptogenic stroke and associated mortality, as reported in one prior study [ 11 ].…”

The impact of COVID-19 on patients with stroke: an integrative review

“…In summary, patients with COVID-19 with a stroke history are more likely to have severe clinical symptoms and poorer outcomes than those without a stroke history. [17,32,33,[35][36][37]. Four out of the 6 stated that NIHSS was significantly higher in stroke patients with COVID-19 than those without the disease [17,32,35,36].…”

“…Fourteen studies reported that the COVID-19 pandemic caused significantly delayed treatment such as alteplase administration, thrombolysis, thrombectomy, or patients' consultation [17][18][19][20][21][22][23][24][25][26][27][28][29][30]. One cohort study asserted that a trend toward more limited alteplase administration was recorded in patients with stroke throughout the COVID-19 pandemic than a year before the outbreak [17]. Likewise, another study shows that the time from stroke symptom onset to emergency room arrival was 22 hours during the pandemic, much longer than usual, resulting in delayed treatment [18].…”

Difficulties and Countermeasures in Hospital Emergency Management for Fast-Lane Treatment of Acute Stroke During the COVID-19 Epidemic Prevention and Control

“…Underlying biological, genetic, or epigenetic characteristics along with less access to healthcare, and social and economic disparities might predispose to health differences and outcomes (32,33). 84.6% of strokes were cortical and more than 50% of patients had no identifiable source, which were categorized as embolic stroke of unknown source (ESUS) (34). The common large vessel disease with ESUS indicates an increased risk of coagulopathy and endothelial dysfunction.…”