Ischemic stroke in COVID-19 patients: mechanisms, treatment and outcomes in a consecutive Swiss Stroke Registry analysis.
Publisher DOI
PubMed ID
34845794
Abstract
BACKGROUND
Most case series of patients with ischemic stroke (IS) and COVID-19 are limited to selected centers or lack 3-month outcome. Aim of this study is to describe frequency, clinical and radiological features, and 3-month outcomes of patients with IS and COVID-19 in a nationwide stroke registry.
METHODS
From the Swiss Stroke Registry (SSR), we included all consecutive IS patients ≥18 years admitted to Swiss Stroke Centers or Stroke Units during the first wave of COVID-19 (25/02 to 08/06/2020). We compared baseline features, etiology and 3-month outcome of SARS-CoV-2 PCR+ IS patients to SARS-CoV-2 PCR- and/or asymptomatic non-tested IS patients.
RESULTS
Of the 2341 IS patients registered in the SSR during the study period, 36 (1.5%) had confirmed COVID-19 infection, of whom 33 within one month before or after stroke onset. In multivariate analysis, COVID+ patients had more lesions in multiple vascular territories (OR=2.35, 95%CI=1.08-5.14, p=0.032) and less cryptogenic strokes (OR=0.37, 95%CI=0.14-0.99, p=0.049). COVID-19 was judged the likely principal cause of stroke in 8 patients (24%), a contributing/triggering factor in 12(36%) and likely not contributing to stroke in 13(40%). There was a strong trend towards worse functional outcome in COVID+ patients after propensity score (PS) adjustment for age, stroke severity and revascularization treatments (PS-adjusted common OR for shift towards higher mRS=1.85, 95%CI 0.96-3.58, p=0.07).
CONCLUSION
In this nationwide analysis of consecutive ischemic strokes, concomitant COVID-19 was relatively rare. COVID+ patients more often had multi-territory stroke and less often cryptogenic stroke, and their 3-month functional outcome tended to be worse.
Most case series of patients with ischemic stroke (IS) and COVID-19 are limited to selected centers or lack 3-month outcome. Aim of this study is to describe frequency, clinical and radiological features, and 3-month outcomes of patients with IS and COVID-19 in a nationwide stroke registry.
METHODS
From the Swiss Stroke Registry (SSR), we included all consecutive IS patients ≥18 years admitted to Swiss Stroke Centers or Stroke Units during the first wave of COVID-19 (25/02 to 08/06/2020). We compared baseline features, etiology and 3-month outcome of SARS-CoV-2 PCR+ IS patients to SARS-CoV-2 PCR- and/or asymptomatic non-tested IS patients.
RESULTS
Of the 2341 IS patients registered in the SSR during the study period, 36 (1.5%) had confirmed COVID-19 infection, of whom 33 within one month before or after stroke onset. In multivariate analysis, COVID+ patients had more lesions in multiple vascular territories (OR=2.35, 95%CI=1.08-5.14, p=0.032) and less cryptogenic strokes (OR=0.37, 95%CI=0.14-0.99, p=0.049). COVID-19 was judged the likely principal cause of stroke in 8 patients (24%), a contributing/triggering factor in 12(36%) and likely not contributing to stroke in 13(40%). There was a strong trend towards worse functional outcome in COVID+ patients after propensity score (PS) adjustment for age, stroke severity and revascularization treatments (PS-adjusted common OR for shift towards higher mRS=1.85, 95%CI 0.96-3.58, p=0.07).
CONCLUSION
In this nationwide analysis of consecutive ischemic strokes, concomitant COVID-19 was relatively rare. COVID+ patients more often had multi-territory stroke and less often cryptogenic stroke, and their 3-month functional outcome tended to be worse.
Date Issued
2022-03
Publication Type
Article
Subject(s)
Subjects
COVID-19 SARS-CoV-2 ischemic stroke
Language(s)
en
Author(s)
Strambo, Davide | |
De Marchis, Gian Marco | |
Bonati, Leo H | |
Carrera, Emmanuel | |
Galletta, Santi | |
Kahles, Timo | |
Cereda, Carlo W | |
Bianco, Giovanni | |
Kägi, Georg | |
Luft, Andreas R | |
Bolognese, Manuel | |
Lakatos, Lehel-Barna | |
Salmen, Stephan | |
Correia, Pamela | |
Sturzenegger, Rolf | |
Sylvan, Albert | |
Medlin, Friedrich | |
Berger, Christian | |
Lindheimer, Florian | |
Baumgärtner, Markus | |
Schelosky, Ludwig | |
Bonvin, Christophe | |
Rodic, Biljana | |
von Reding, Andrea | |
Schwegler, Guido | |
Massini, Federico | |
Tarnutzer, Alexander A | |
Taheri, Shadi | |
Peters, Nils | |
Altersberger, Valerian | |
Engelter, Stefan T | |
Michel, Patrik |
Additional Credits
Journal
European journal of neurology
Publisher
Blackwell Science
ISSN
1351-5101
Access(Rights)
open.access