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Association of Coronavirus Disease (COVID-19) With Large Vessel Occlusion Strokes: A Case-Control Study
- Source :
- AJR. American journal of roentgenology. 216(1)
- Publication Year :
- 2020
-
Abstract
- BACKGROUND. An increase in frequency of acute ischemic strokes has been observed among patients presenting with acute neurologic symptoms during the coronavirus disease (COVID-19) pandemic. OBJECTIVE. The purpose of this study was to investigate the association between COVID-19 and stroke subtypes in patients presenting with acute neurologic symptoms. METHODS. This retrospective case-control study included patients for whom a code for stroke was activated from March 16 to April 30, 2020, at any of six New York City hospitals that are part of a single health system. Demographic data (age, sex, and race or ethnicity), COVID-19 status, stroke-related risk factors, and clinical and imaging findings pertaining to stroke were collected. Univariate and multivariate analyses were conducted to evaluate the association between COVID-19 and stroke subtypes. RESULTS. The study sample consisted of 329 patients for whom a code for stroke was activated (175 [53.2%] men, 154 [46.8%] women; mean age, 66.9 ± 14.9 [SD] years). Among the 329 patients, 35.3% (116) had acute ischemic stroke confirmed with imaging; 21.6% (71) had large vessel occlusion (LVO) stroke; and 14.6% (48) had small vessel occlusion (SVO) stroke. Among LVO strokes, the most common location was middle cerebral artery segments M1 and M2 (62.0% [44/71]). Multifocal LVOs were present in 9.9% (7/71) of LVO strokes. COVID-19 was present in 38.3% (126/329) of the patients. The 61.7% (203/329) of patients without COVID-19 formed the negative control group. Among individual stroke-related risk factors, only Hispanic ethnicity was significantly associated with COVID-19 (38.1% of patients with COVID-19 vs 20.7% of patients without COVID-19; p = 0.001). LVO was present in 31.7% of patients with COVID-19 compared with 15.3% of patients without COVID-19 (p = 0.001). SVO was present in 15.9% of patients with COVID-19 and 13.8% of patients without COVID-19 (p = 0.632). In multivariate analysis controlled for race and ethnicity, presence of COVID-19 had a significant independent association with LVO stroke (odds ratio, 2.4) compared with absence of COVID-19 (p = 0.011). CONCLUSION. COVID-19 is associated with LVO strokes but not with SVO strokes. CLINICAL IMPACT. Patients with COVID-19 presenting with acute neurologic symptoms warrant a lower threshold for suspicion of large vessel stroke, and prompt workup for large vessel stroke is recommended.
- Subjects :
- Male
medicine.medical_specialty
Computed Tomography Angiography
Arterial Occlusive Diseases
Neuroimaging
Magnetic resonance angiography
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
medicine.artery
medicine
Humans
Radiology, Nuclear Medicine and imaging
Stroke
Computed tomography angiography
Aged
Retrospective Studies
medicine.diagnostic_test
business.industry
SARS-CoV-2
Case-control study
COVID-19
Retrospective cohort study
General Medicine
Odds ratio
medicine.disease
Cerebral Angiography
030220 oncology & carcinogenesis
Case-Control Studies
Middle cerebral artery
Cardiology
Female
New York City
business
Magnetic Resonance Angiography
Cerebral angiography
Subjects
Details
- ISSN :
- 15463141
- Volume :
- 216
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- AJR. American journal of roentgenology
- Accession number :
- edsair.doi.dedup.....21ae47ae36234db8ebb323b4fb963dce