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Croatian study on COVID-19-positive stroke patients during the second wave of the pandemic

Stela Rutović1, Davor Sporiš, Miljenko Crnjaković

  • 1Stela Rutović, Department of Neurology, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia, stela.rutovic@gmail.com.

Croatian Medical Journal
|November 3, 2022
PubMed

Insights

Ischemic stroke characteristics differ when coronavirus disease 2019 (COVID-19) occurs before or after stroke. Both groups experienced severe outcomes, highlighting the need for optimized stroke care.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Public Health

Background:

  • The second wave of the COVID-19 pandemic presented unique challenges for healthcare systems globally.
  • Understanding the interplay between COVID-19 infection and cerebrovascular events like ischemic stroke is crucial.

Purpose of the Study:

  • To investigate and compare the characteristics of ischemic stroke in patients with concomitant coronavirus disease 2019 (COVID-19) infection in Croatia.
  • To differentiate stroke etiology based on the timing of COVID-19 infection relative to stroke onset.

Main Methods:

  • A retrospective study analyzing data from 255 ischemic stroke patients across 12 Croatian hospitals.
  • Patients were categorized into two groups: COVID-19 infection preceding stroke, and COVID-19 infection during hospitalization post-stroke.
  • Stroke etiology was classified using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria.

Main Results:

  • Significant differences in stroke etiology were observed between the groups (P=0.038).
  • Patients with pre-stroke COVID-19 exhibited fewer cardioembolic strokes (29.1% vs 46%) and more cryptogenic strokes (14.3% vs 32.5%) compared to those with post-stroke COVID-19.
  • High rates of large-vessel occlusions (44.4%-49.6%) and severe outcomes (median modified Rankin Scale score of 4, mortality 33.3%-36.4%) were noted in both groups.

Conclusions:

  • Ischemic stroke etiology varies depending on whether COVID-19 infection precedes or follows the stroke event.
  • Both patient cohorts presented with significant disability and high mortality rates.
  • Enhanced awareness of prehospital stroke symptoms and optimized clinical workflows are essential for improving outcomes through acute recanalization therapies.
Abstract

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