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Early Brain Imaging Shows Increased Severity of Acute Ischemic Strokes With Large Vessel Occlusion in COVID-19 Patients
- Source :
- Stroke
- Publication Year :
- 2020
-
Abstract
- Background and Purpose: Reports are emerging regarding the association of acute ischemic strokes with large vessel occlusion and coronavirus disease 2019 (COVID-19). While a higher severity of these patients could be expected from the addition of both respiratory and neurological injury, COVID-19 patients with strokes can present with mild or none respiratory symptoms. We aimed to compare anterior circulation large vessel occlusion strokes severity between patients with and without COVID-19. Methods: We performed a comparative cohort study between patients with COVID-19 who had anterior circulation large vessel occlusion and early brain imaging within 3 hours from onset, in our institution during the 6 first weeks of the COVID-19 outbreak and a control group admitted during the same calendar period in 2019. Results: Twelve COVID-19 patients with anterior circulation large vessel occlusion and early brain imaging were included during the study period and compared with 34 control patients with anterior circulation large vessel occlusion and early brain imaging in 2019. Patients in the COVID-19 group were younger ( P =0.032) and had a history of diabetes mellitus more frequently ( P =0.039). Patients did not significantly differ on initial National Institutes of Health Stroke Scale nor time from onset to imaging ( P =0.18 and P =0.6, respectively). Patients with COVID-19 had more severe strokes than patients without COVID-19, with a significantly lower clot burden score (median: 6.5 versus 8, P =0.016), higher rate of multivessel occlusion (50% versus 8.8%, P =0.005), lower DWI-ASPECTS (Diffusion-Weighted Imaging–Alberta Stroke Program Early CT Scores; median: 5 versus 8, P =0.006), and higher infarct core volume (median: 58 versus 6 mL, P =0.004). Successful recanalization rate was similar in both groups ( P =0.767). In-hospital mortality was higher in the COVID-19 patients’ group (41.7% versus 11.8%, P =0.025). Conclusions: Early brain imaging showed higher severity large vessel occlusion strokes in patients with COVID-19. Given the massive number of infected patients, concerns should be raised about the coming neurovascular impact of the pandemic worldwide.
- Subjects :
- Male
Computed Tomography Angiography
coronavirus
Severity of Illness Index
Magnetic resonance angiography
Thrombolytic Therapy
Hospital Mortality
Stroke
Infarction, Anterior Cerebral Artery
Computed tomography angiography
Thrombectomy
Aged, 80 and over
medicine.diagnostic_test
Brief Report
Infarction, Middle Cerebral Artery
Middle Aged
stroke
Cardiology
Female
Cardiology and Cardiovascular Medicine
Coronavirus Infections
Cerebral angiography
medicine.medical_specialty
brain
Pneumonia, Viral
Ischemia
ischemia
Betacoronavirus
Infarction, Posterior Cerebral Artery
Neuroimaging
Internal medicine
Severity of illness
medicine
Humans
Pandemics
Aged
Advanced and Specialized Nursing
business.industry
SARS-CoV-2
Case-control study
COVID-19
medicine.disease
Cerebral Angiography
Diffusion Magnetic Resonance Imaging
Case-Control Studies
Neurology (clinical)
prognosis
business
Magnetic Resonance Angiography
Subjects
Details
- ISSN :
- 15244628
- Volume :
- 51
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Stroke
- Accession number :
- edsair.doi.dedup.....2f0fa385f8f59cdbae9d1dada7e7e67c