The effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on ischemic stroke and the possible underlying mechanisms

Abstract

Purpose: As of November 28, 2020, COVID-19 has been reported in 220 countries with 61,036,793 confirmed cases and 1,433,316 confirmed deaths; countries became vigilant around the world. In addition to SARS-CoV-2 causing pneumonia, many studies have reported ischemic stroke in patients with COVID-19. This article describes the effects and possible underlying mechanisms of SARS-CoV-2 on ischemic stroke. Materials and methods: A literature search was performed using PubMed, Web of Science, and other COVID-dedicated databases and the combination of the keywords ‘SARS-CoV-2’, ‘COVID-19’ and ‘ischemic stroke’ up to November 28, 2020. Results: SARS-CoV-2 invades the host through angiotensin converting enzyme 2 (ACE2). ACE2 is expressed not only in the lungs, but also in the brain and vascular endothelial cells. SARS-CoV-2 infection might cause direct vascular disease or enhance the immunogenic thrombosis environment through several mechanisms. SARS-CoV-2 infection can modulate the host immune response and can cause inflammation, coagulation disorders, renin angiotensin system disorders, hypoxia, and stress disorders, which may lead to the occurrence of ischemic stroke. Conclusions: Some patients with COVID-19 can develop ischemic stroke. Ischemic stroke has a high risk of causing disability and is associated with a high mortality rate. It is hoped that when medical staff treat patients with COVID-19, they would pay attention to the occurrence of ischemic stroke to improve the prognosis of patients with COVID-19.

Association between SARS-CoV-2 Seropositivity and Severity of Out-of-Hospital Acute Ischemic Stroke Following Asymptomatic/Mild COVID-19 in Children

“…The induced excessive CRP and proinflammatory cytokines, such as interleukin (IL)-6, IL-8, and tumor necrosis factor-α (cytokine storm), can provoke hypercoagulability status, microvascular damage, and thrombotic microangiopathy. 9 27 Moreover, neutrophil activation and neutrophil extracellular traps formation could trigger thrombosis. 3 27 On the other hand, SARS-CoV-2 can bind with angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in various human tissues, including cardiovascular and central nervous systems.…”

“…However, several studies have shown that AIS may occur even in patients with no or minimal symptoms of SARS-CoV-2 infection. 21,27 For instance, Vielleux et al 18 reported three children with AIS developed after mild or asymptomatic Association between SARS-CoV-2 Seropositivity and Severity of Out-of-Hospital Acute Ischemic Stroke Abdelkreem et al…”

“…Advanced age, cerebrovascular comorbidities (e.g., hypertension, diabetes mellitus, and hyperlipidemia), and more severe COVID-19 are known risk factors for AIS related to acute SARS-CoV-2 infection, but they likely have limited role in delayed AIS that occur several weeks or months after that. 27,30 Of note, we could not determine the specific timing of SARS-CoV-2 infection in relation to AIS since our study participants were identified to be COVID-19 seropositive at the time of admission; they were not previously diagnosed with COVID-19 and had no or mild symptoms of acute infection.…”

“…Association between SARS-CoV-2 Seropositivity and Severity of Out-of-Hospital Acute Ischemic Stroke Abdelkreem et altrigger thrombosis 3,27. On the other hand, SARS-CoV-2 can bind with angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in various human tissues, including cardiovascular and central nervous systems.…”

Application of Integrated Emergency Care Model Based on Failure Modes and Effects Analysis in Patients With Ischemic Stroke

“…Acute ischemic stroke (AIS) is the most prevalent type of stroke in clinical practice, accounting for more than 80% of strokes, and it is a major public health problem that threatens national health in my country ( 1 ). The disease is mostly secondary to systemic diseases such as hypertension ( 2 ), atherosclerosis ( 3 ), heart disease ( 4 ) and coagulation dysfunction ( 5 ), and is characterized by a high recurrence rate, high disability rate, high complication rate and high mortality rate. The key to AIS treatment is to restore blood flow to the occluded vessel and save the ischemic penumbra within the treatment time window (i.e., 3 to 4.5 h after the onset of stroke) ( 6 ).…”