Characteristics of Large-Vessel Occlusion Associated with COVID-19 and Ischemic Stroke
Seby John1,2, Praveen Kesav3, Victoria Ann Mifsud3
1Department of Neurology (S.J., P.K., V.A.M., B.P.-J., S.I.H.), Neurological Institute johns5@clevelandclinicabudhabi.ae.
Insights
COVID-19 is linked to severe ischemic strokes, often affecting young males with large-vessel occlusions. These strokes may stem from COVID-19-induced hypercoagulable states or endothelial damage, leading to poor outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Vascular Medicine
Background:
- The relationship between COVID-19 and ischemic stroke, particularly large-vessel occlusion (LVO), requires further elucidation.
- Understanding stroke characteristics during the pandemic is crucial for clinical management and public health.
- Baseline stroke data comparison is essential to assess pandemic-related impacts.
Purpose of the Study:
- To investigate the mechanisms and clinical phenotype of ischemic stroke in patients with COVID-19.
- To identify characteristics of COVID-19 associated ischemic strokes, focusing on LVO.
- To compare stroke admissions during the pandemic with historical data.
Main Methods:
- Retrospective analysis of ischemic stroke and TIA admissions between March 1 and May 10, 2020 (COVID-19 and non-COVID).
- Identification and characterization of COVID-19 patients with acute ischemic stroke and LVO.
- Comparison of stroke data from 2020 with the same period in 2019.
Main Results:
- Among 20 COVID-19 patients with ischemic stroke, 15 (75%) had LVO.
- COVID-19 stroke patients were younger (mean age 46.5), predominantly male (93%), and lacked traditional cardiovascular risk factors.
- LVOs involved multiple, uncommon vessels in atypical locations with large thrombus burden; systemic thrombosis occurred in 26%.
Conclusions:
- COVID-19 ischemic stroke, especially LVO, presents severely in younger individuals and is associated with poor outcomes.
- Findings suggest stroke may be linked to COVID-19-induced hypercoagulable state and/or endothelial damage.
- Stroke etiology remained undetermined in nearly half of cases, highlighting diagnostic challenges.
Abstract:
The mechanisms and phenotype of ischemic stroke associated with coronavirus disease 2019 (COVID-19) remain uncertain. A retrospective study was conducted in patients with COVID-19 presenting with ischemic stroke from March 1 to May 25, 2020, and cases with large-vessel occlusion were identified. To provide baseline institutional stroke data within and outside the COVID-19 pandemic, all consecutive ischemic stroke and TIA admissions (COVID and non-COVID) to the hospital during a 10-week period from March 1 to May 10, 2020, were collected and compared with data from the same time period in 2019. Among 20 patients with COVID-19 and acute ischemic stroke, 15 (75%) had large-vessel occlusion. These patients were young (mean age, 46.5 years), male (93%), without major burden of traditional cardiovascular risk factors, and had a severe stroke presentation. Large-vessel occlusions were observed in multiple vessels (40%), uncommonly affected vessels, and atypical locations with a large thrombus burden. Systemic thrombosis separate from large-vessel occlusion was not uncommon (26%). At short-term follow-up, stroke etiology remained undetermined in 46% of patients and functional outcome was poor. The above findings raise the possibility of stroke related to mechanisms induced by the COVID-19 infection itself, including a hypercoagulable state and/or endothelial damage. In addition, they document the severe presentation and poor outcomes of large-vessel occlusion in COVID-19 ischemic stroke.
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