Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke

Chalumeau²,

et al. 2020

Stroke

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 Computed Tomography 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.

Section: Methodsmentioning

confidence: 99%

Early Brain Imaging Shows Increased Severity of Acute Ischemic Strokes With Large Vessel Occlusion in COVID-19 Patients

Chalumeau²,

et al. 2020

Stroke

“…None of our patients were eligible for thrombolytic treatment. For acute ischemic stroke secondary prevention, our patients were treated based on American Heart Association/American Stroke Association guideline 2019 [ 7 ]. Seven of our patients received antiplatelet.…”

Section: Resultsmentioning

confidence: 99%

Ischemic Stroke in Patients with COVID-19 Disease: A Report of 10 Cases from Iran

et al. 2020

Ischemic stroke seems to be one of the most serious neurologic complications in patients with COVID-19 infection. Herein, we report a series of 10 ischemic stroke patients with concomitant COVID-19 disease. Out of 10, 8 had large infarcts (3 massive middle cerebral artery, 2 basilar artery, 2 posterior cerebral artery, and 1 internal carotid artery infarct territory). Two had cardiogenic embolic stroke due to atrial fibrillation. Almost half of our patients did not have a vascular risk factor. Nine did not have fever and were diagnosed with COVID-19 upon admission for stroke. Stroke occurred in the first week of respiratory symptoms with moderate pulmonary involvement. Most Patients did not have hypoxia and did not establish respiratory failure or acute respiratory distress syndrome. The blood pressures were low and hemorrhagic transformation did not occur even after antiplatelet or anticoagulant therapy. Patients had markedly increased levels of lactate dehydrogenase, C-reactive protein, and D-dimer. Three patients died. It seems that ischemic strokes in COVID-19 patients tend to occur as large infarct and can be seen in patients with mild to moderate pulmonary involvement.

“…Participants with ACI should match the diagnostic criteria of cerebral infarction revised from the 4th National Conference on Cerebrovascular Diseases in 1995, the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2014 and 2018 editions or the Guidelines for the Early Management of Patients with Acute Ischemic Stroke 2019 edition. [ 22 – 25 ]…”

Section: Methodsmentioning

confidence: 99%

Effectiveness comparisons of different Chinese herbal injection therapies for acute cerebral infarction

Liu

et al. 2020

Medicine

Background: Acute cerebral infarction (ACI) has a high incidence, recurrence rate, and mortality. Chinese herbal injections (CHIs) are widely used in the substitution therapy of ACI. Due to the lack of randomized trials comparing the efficacy of various injections directly, it is still difficult to judge the relative efficacy. Therefore, we intend to conduct a network meta-analysis to evaluate the benefit among these CHIs. Methods: According to the retrieval strategies, randomized controlled trials (RCTs) on CHI therapies for ACI will be obtained from China National Knowledge Infrastructure, WanFang, Chinese Scientific Journals Database, PubMed, Embase and Cochrane Library, regardless of publication date or language. Studies were screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool will be used to evaluate the quality of the literature. The network meta-analysis will be performed in Markov Chain Monte Carlo method and carried out with Stata 14 and WinBUGS 1.4.3 software. Ultimately, the evidentiary grade for the results will be evaluated. Results: This study will compare the efficacy and safety of CHIs in the treatment of ACI, and give a more reasonable choice. Conclusion: Our findings will provide references for future clinical decision and guidance developing. INPLASY registration number: INPLASY202060087.