SARS-CoV-2 infection predicts larger infarct volume in patients with acute ischemic stroke

Abstract

Background and purposeAcute ischemic stroke (AIS) is a fearful complication of Coronavirus Disease-2019 (COVID-19). Aims of this study were to compare clinical/radiological characteristics, endothelial and coagulation dysfunction between acute ischemic stroke (AIS) patients with and without COVID-19 and to investigate if and how the SARS-CoV-2 spike protein (SP) was implicated in triggering platelet activation.MethodsWe enrolled AIS patients with COVID-19 within 12 h from onset and compared them with an age- and sex-matched cohort of AIS controls without COVID-19. Neuroimaging studies were performed within 24 h. Blood samples were collected in a subset of 10 patients.ResultsOf 39 AIS patients, 22 had COVID-19 and 17 did not. Admission levels of Factor VIII and von Willebrand factor antigen were significantly higher in COVID-19 patients and positively correlated with the infarct volume. In multivariate linear regression analyses, COVID-19 was an independent predictor of infarct volume (B 20.318, Beta 0.576, 95%CI 6.077–34.559; p = 0.011). SP was found in serum of 2 of the 10 examined COVID-19 patients. Platelets from healthy donors showed a similar degree of procoagulant activation induced by COVID-19 and non-COVID-19 patients' sera. The anti-SP and anti-FcγRIIA blocking antibodies had no effect in modulating platelet activity in both groups.ConclusionsSARS-CoV-2 infection seems to play a major role in endothelium activation and infarct volume extension during AIS.

Familial hypercholesterolemia: The nexus of endothelial dysfunction and lipoprotein metabolism in COVID-19

“…In this meta-analysis, in those patients who had preexisting coronary artery disease, the odds ratio (OR) for the acute cerebrovascular disease was 43.12 (95% CI 1.61–6.02). Preexisting cardiovascular risk factors also predispose to an ischemic stroke in patients with COVID-19 as found in a large multiethnicity registry study and a meta-analysis [44,45]. In addition, the prognosis of stroke is worse in patients with COVID-19 [46–48].…”

Pathogenic mechanisms of cardiovascular damage in COVID-19

“…COVID-19 patients hospitalized at the time of the infection have a subsequent higher risk of stroke during the follow-up compared to those non-hospitalized (Zuin et al 2023a). Moreover, a recent study demonstrated that COVID-19 extends the infarct volume during acute ischemic stroke (De Michele et al 2023). COVID-19-related ischemic stroke may occur in all age groups and predominantly in males.…”

“…There is increasing evidence that COVID-19 is associated with ischemic stroke (Finsterer et al 2022;Ozcan et al 2023;De Michele et al 2023). An increasing number of COVID-19 patients with ischemic stroke have been reported (Luo et al 2022;Zuin et al 2023a).…”

“…The anterior circulation is more frequently affected than the posterior circulation (Finsterer et al 2022). The mechanisms underlying ischemic stroke are thought to be driven by multiple pathophysiological factors, including hypercoagulation, microthrombosis, and endothelial dysfunction (De Michele et al 2023). Immune-mediated thrombosis, the RAAS and the effect of SARS-CoV-2 in cardiac and brain tissue may also contribute to the pathogenesis of ischemic stroke in patients with COVID-19 (Sagris et al 2021).…”

COVID-19 Complications: Oxidative Stress, Inflammation, and Mitochondrial and Endothelial Dysfunction

“…This leads to endothelial dysfunction, characterized by impaired vasodilation, increased vascular inflammation, and a prothrombotic state [93]. This dysfunction is a critical factor in the development of various acute conditions [35,94,95], etc., and it can further exacerbate OS itself, creating a vicious cycle [96].…”