Ischemic stroke in COVID‐19 patients: Mechanisms, treatment, and outcomes in a consecutive Swiss Stroke Registry analysis

Abstract

Background Most case series of patients with ischemic stroke (IS) and COVID‐19 are limited to selected centers or lack 3‐month outcomes. The aim of this study was to describe the frequency, clinical and radiological features, and 3‐month outcomes of patients with IS and COVID‐19 in a nationwide stroke registry. Methods From the Swiss Stroke Registry (SSR), we included all consecutive IS patients ≥18 years admitted to Swiss Stroke Centers or Stroke Units during the first wave of COVID‐19 (25 February to 8 June 2020). We compared baseline features, etiology, and 3‐month outcome of SARS‐CoV‐2 polymerase chain reaction‐positive (PCR+) IS patients to SARS‐CoV‐2 PCR− and/or asymptomatic non‐tested IS patients. Results Of the 2341 IS patients registered in the SSR during the study period, 36 (1.5%) had confirmed COVID‐19 infection, of which 33 were within 1 month before or after stroke onset. In multivariate analysis, COVID+ patients had more lesions in multiple vascular territories (OR 2.35, 95% CI 1.08–5.14, p = 0.032) and fewer cryptogenic strokes (OR 0.37, 95% CI 0.14–0.99, p = 0.049). COVID‐19 was judged the likely principal cause of stroke in 8 patients (24%), a contributing/triggering factor in 12 (36%), and likely not contributing to stroke in 13 patients (40%). There was a strong trend towards worse functional outcome in COVID+ patients after propensity score (PS) adjustment for age, stroke severity, and revascularization treatments (PS‐adjusted common OR for shift towards higher modified Rankin Scale (mRS) = 1.85, 95% CI 0.96–3.58, p = 0.07). Conclusions In this nationwide analysis of consecutive ischemic strokes, concomitant COVID‐19 was relatively rare. COVID+ patients more often had multi‐territory stroke and less often cryptogenic stroke, and their 3‐month functional outcome tended to be worse.

COVID-19 independently predicts poor outcomes in Acute Ischemic Stroke- Insights from a multicenter study from Pakistan and United Arab Emirates

“…The other significant difference was observed in involvement of multiple vascular territories consistent with an earlier report 13 and hemorrhagic transformation, which were both more significantly found in COVID positive strokes. The former may be attributable to the underlying mechanism of hypercoagulability, as earlier reported 14 .…”

Therapeutic Trends of Cerebrovascular Disease during the COVID-19 Pandemic and Future Perspectives

“…Some of the earliest reports estimated the risk of stroke among hospitalized patients with COVID-19 between 1% and 5% [ 1 , 2 , 4 , 22 ], with a higher risk among more critically ill patients, patients with higher D-dimer levels and other laboratory biomarkers of inflammatory activity [ 23 ]. Conversely, the rate of COVID-19 among patients hospitalized with stroke has been reported to range from 1.5% to 3.3% [ 1 , 24 ]. Although the risk of cerebrovascular disease has not been specifically studied among the emerging variants, the omicron variant may have milder severity with a lower risk of hospitalization when compared to the delta [ 25 ] and other variants.…”

Weighted Gene Co-Expression Network Analysis to Identify Potential Biological Processes and Key Genes in COVID-19-Related Stroke

“…Since December 2019, severe acute respiratory syndrome coronavirus 2- (SARS-CoV-2-) induced coronavirus disease 2019 (COVID-19) has been causing significant morbidity and mortality around the world [ 1 , 2 ]. According to a World Stroke Organization panel review, the risk of ischemic stroke increases by approximately 5% during COVID-19 [ 3 ].…”