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Incidence, Characteristics and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study

Priyank Khandelwal1, Fawaz Al-Mufti2, Ambooj Tiwari3

  • 1Department of Neurological Surgery, University Hospital Newark, New Jersey Medical School, Rutgers, New Jersey, USA.

Neurosurgery
|March 18, 2021
PubMed

Insights

Acute ischemic stroke (AIS) in COVID-19 patients is uncommon but characterized by large vessel occlusion (LVO) in younger individuals and disproportionately affects African Americans in the USA.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Public Health

Background:

  • Reports indicate acute ischemic stroke (AIS) in coronavirus disease 2019 (COVID-19) patients.
  • The precise incidence of AIS and clinical features of large vessel occlusion (LVO) in COVID-19 patients require further clarification.

Purpose of the Study:

  • To determine the incidence of AIS among patients diagnosed with COVID-19.
  • To characterize the clinical presentation of LVO in hospitalized COVID-19 patients.

Main Methods:

  • A retrospective, international, multicenter study was conducted.
  • Data were collected from 12 stroke centers across 4 countries between March 1 and May 1, 2020.
  • Incidence of AIS was calculated from 9 centers admitting all stroke types; LVO data were collected from all 12 centers, including those specializing in LVO and mechanical thrombectomy (MT).

Main Results:

  • The incidence of stroke among 6,698 COVID-19 patients was 1.3% (IQR 0.75%-1.7%).
  • Among 66 LVO cases, the median age was 51 years, with 16% under 50.
  • In US centers, 28% of LVO patients were African American; average time from symptom onset to presentation for MT-eligible LVO was 558 minutes.

Conclusions:

  • Large vessel occlusion (LVO) is a notable finding in patients with acute ischemic stroke (AIS) and COVID-19.
  • These strokes occur in a younger demographic compared to the general stroke population.
  • African Americans in the USA were disproportionately affected by LVO in the context of COVID-19.
Abstract

Keywords:
Acute ischemic strokeCOVID-19EpidemiologyLarge vessel occlusion

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