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Published on: June 18, 2021
Cerebral ischemic and hemorrhagic complications of coronavirus disease 2019
Ahmad Sweid1, Batoul Hammoud2, Kimon Bekelis3
1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
Insights
Coronavirus disease 2019 (COVID-19) patients with acute cerebrovascular disease, including stroke, face high mortality rates. This study highlights the challenges and outcomes in managing these complex neurological manifestations.
Area of Science:
- Neurology
- Vascular Medicine
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) is linked to neurological complications, notably stroke.
- Acute cerebrovascular pathologies have been observed in COVID-19 patients.
Purpose of the Study:
- To present a case series of COVID-19 patients with acute cerebrovascular disease.
- To conduct a pooled analysis of large vessel occlusion in COVID-19.
- To summarize the pathophysiology of cerebrovascular disease in COVID-19.
Main Methods:
- Retrospective study of 22 patients diagnosed with COVID-19 and acute cerebrovascular disease across two institutions (March-May 2020).
- Literature review using PubMed for data on large vessel occlusion in COVID-19.
- Analysis of patient demographics, cerebrovascular pathologies, interventions, and outcomes.
Main Results:
- The study included 22 patients (mean age 59.5 years, 12 female) with 17 ischemic strokes, 3 aneurysms, and 2 sinus thromboses.
- Mechanical thrombectomy was performed in 16 patients (84.2%), achieving favorable reperfusion.
- Despite interventions, mortality was high (36.4%), with 31.3% mortality in thrombectomy patients; 50% had poor functional status at discharge.
Conclusions:
- COVID-19 patients with large vessel occlusion exhibit high mortality rates, even with timely intervention.
- Unique features include younger patients, arterial and venous involvement, and challenging clot characteristics.
- Management of cerebrovascular disease in COVID-19 requires careful consideration of these factors.
Background:
The coronavirus disease 2019 is associated with neurological manifestations including stroke.
Objectives:
We present a case series of coronavirus disease 2019 patients from two institutions with acute cerebrovascular pathologies. In addition, we present a pooled analysis of published data on large vessel occlusion in the setting of coronavirus disease 2019 and a concise summary of the pathophysiology of acute cerebrovascular disease in the setting of coronavirus disease 2019.
Methods:
A retrospective study across two institutions was conducted between 20 March 2020 and 20 May 2020, for patients developing acute cerebrovascular disease and diagnosed with coronavirus disease 2019. We performed a literature review using the PubMed search engine.
Results:
The total sample size was 22 patients. The mean age was 59.5 years, and 12 patients were female. The cerebrovascular pathologies were 17 cases of acute ischemic stroke, 3 cases of aneurysm rupture, and 2 cases of sinus thrombosis. Of the stroke and sinus thrombosis patients, the mean National Institute of Health Stroke Scale was 13.8 ± 8.0, and 16 (84.2%) patients underwent a mechanical thrombectomy procedure. A favorable thrombolysis in cerebral infarction score was achieved in all patients. Of the 16 patients that underwent a mechanical thrombectomy, the mortality incidence was five (31.3%). Of all patients (22), three (13.6%) patients developed hemorrhagic conversion requiring decompressive surgery. Eleven (50%) patients had a poor functional status (modified Rankin Score 3-6) at discharge, and the total mortality incidence was eight (36.4%).
Conclusions:
Despite timely intervention and favorable reperfusion, the mortality rate in coronavirus disease 2019 patients with large vessel occlusion was high in our series and in the pooled analysis. Notable features were younger age group, involvement of both the arterial and venous vasculature, multivessel involvement, and complicated procedures due to the clot consistency and burden.
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