Incidence, Characteristics and Outcomes of Large Vessel Stroke in COVID-19 Cohort: A Multicentric International Study.

12 Pages Posted: 8 Jun 2020 Last revised: 7 May 2021

See all articles by Priyank Khandelwal

Priyank Khandelwal

Rutgers, The State University of New Jersey - Department of Neurosurgery

Fawaz Al Mufti

New York Medical College - Department of Neurology, Radiology and Neurosurgery

Ambooj Tiwari Tiwari

New York University (NYU) - Department of Neurology

Amit Singla

Rutgers, The State University of New Jersey - New Jersey Medical School

Adam Dmytriw

University of Toronto

Mariangela Piano

Grande Ospedale Metropolitano Niguarda

Luca Quilici

Grande Ospedale Metropolitano Niguarda

Guglielmo Pero

Grande Ospedale Metropolitano Niguarda

Leonardo Renieri

Careggi University Hospital of Florence

Nicola Limbucci

Careggi University Hospital of Florence

Mario Martínez-Galdámez

Hospital Clínico de Valladolid

Miguel Schüller

Hospital Clínico de Valladolid

Jorge Galván

Hospital Clínico de Valladolid

Juan Francisco Arenillas-Lara

University of Valladolid - Department of Neurology

Zafar Hashim

Government of the United Kingdom - University Hospitals of North Midlands

Sanjeev Nayak

Government of the United Kingdom - University Hospitals of North Midlands

Keith Desousa

Northwell Health

Hai Sun

Rutgers, The State University of New Jersey - New Jersey Medical School

Pankaj K Agarwalla

Rutgers, The State University of New Jersey - New Jersey Medical School

Anil Nanda

Rutgers, The State University of New Jersey - New Jersey Medical School

Juan Diogo Lonzano

Riverside Community Hospital

Sudipta Roychoudhury

Robert Wood Johnson University Hospital

Emad Nourollahzadeh

Robert Wood Johnson University Hospital

Chirag Gandhi

New York Medical College - Department of Neurology, Radiology and Neurosurgery

Andrew Xavier

Riverside Community Hospital

Tannavi Prakash

Rutgers, The State University of New Jersey - New Jersey Medical School

Gaurav Gupta

Rutgers, The State University of New Jersey - New Jersey Medical School

Dileep Yavagal

University of Miami - Department of Neurology and Neurosurgery

Date Written: June 2, 2020

Abstract

Importance: Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is a global pandemic that has been an immense burden on the healthcare systems all over the world. While there are case reports of acute ischemic stroke (AIS) the overall incidence of acute ischemic stroke in COVID -19 patients is yet to be determined. Also, whether the hypercoagulability seen in COVID-19 patients leads to larger thromboemboli and hence increase large vessel occlusion stroke (LVOs) is unclear.

Design, Setting, and Participants: This is a retrospective, international multicenter case series of LVOs. Data was collected from March 1, 2020, to May 1, 2020, at 12 stroke centers located in COVID-19 hotspots from 4 different countries. Detailed data was collected on consecutive LVOs hospitalized patients with laboratory-confirmed diagnosis of severe acute respiratory syndrome coronavirus 2 infection.

Main Outcomes and Measures: We measured the incidence of AIS and LVOs in the hospitalized COVID-19 patients. Among patients who underwent Mechanical thrombectomy, we measured the stroke outcomes ( site of occlusion, tandem occlusion, revascularization rates, time to present to the hospital), along with COVID-19 symptoms, and overall outcomes in these patients.

Results Of 6698 patients admitted with COVID-19 patients in 10 centers, the incidence of stroke was noted in 1.3 % (range .6-2.6 %). The median age of patients who presented with LVOs was 51 years mean (range 27-87years and in the US centers, African Americans comprised 28% of the race-ethnic distribution. 10 patients (16 %) were less than 50 y of age with no significant risk factors for LVOs in the majority of them. Among the LVOs eligible for MT, the average time to presentation from symptom onset to emergency room was 9.3 hours. Successful revascularization was achieved in 81% of patients and the intracranial hemorrhage rate was 14% with no symptomatic hemorrhages. 21 (50%) patients were either discharged to home or to acute rehabilitation facilities.

Conclusions and Relevance: LVOs was predominant in patients with AIS and COVID-19, occurring at a significantly younger age and affecting African Americans disproportionately.

Note: Ethical Approval: Respective institutions ethical review board approved the study.

Funding: None to declare

Declaration of Interest: Dr Yavagal is a consultant to Medtronic , Cerenovus, Rapid Medical, Vascular Dynamics, Poseydon, Neurosave & Neuralanalytics outside the submitted work.

Keywords: COVID-19, Young Stroke, Incidence of Stroke in COVID-19 admissions, Large Vessel Occlusions in COVID-19 Admissions

JEL Classification: I

Suggested Citation

Khandelwal, Priyank and Mufti, Fawaz Al and Tiwari, Ambooj Tiwari and Singla, Amit and Dmytriw, Adam and Piano, Mariangela and Quilici, Luca and Pero, Guglielmo and Renieri, Leonardo and Limbucci, Nicola and Martínez-Galdámez, Mario and Schüller, Miguel and Galván, Jorge and Arenillas-Lara, Juan Francisco and Hashim, Zafar and Nayak, Sanjeev and Desousa, Keith and Sun, Hai and Agarwalla, Pankaj K and Nanda, Anil and Lonzano, Juan Diogo and Roychoudhury, Sudipta and Nourollahzadeh, Emad and Gandhi, Chirag D. and Xavier, Andrew R. and Prakash, Tannavi and Gupta, Gaurav and Yavagal, Dileep, Incidence, Characteristics and Outcomes of Large Vessel Stroke in COVID-19 Cohort: A Multicentric International Study. (June 2, 2020). Available at SSRN: https://ssrn.com/abstract=3617195 or http://dx.doi.org/10.2139/ssrn.3617195

Priyank Khandelwal (Contact Author)

Rutgers, The State University of New Jersey - Department of Neurosurgery ( email )

90 Bergen Street
Suite 8100
Newark, NJ 07103
United States

Fawaz Al Mufti

New York Medical College - Department of Neurology, Radiology and Neurosurgery

Valhalla, NY
United States

Ambooj Tiwari Tiwari

New York University (NYU) - Department of Neurology

New York City, NY
United States

Amit Singla

Rutgers, The State University of New Jersey - New Jersey Medical School

NJ
United States

Adam Dmytriw

University of Toronto

Toronto, Ontario M5S 3G8
Canada

Mariangela Piano

Grande Ospedale Metropolitano Niguarda

Italy

Luca Quilici

Grande Ospedale Metropolitano Niguarda

Italy

Guglielmo Pero

Grande Ospedale Metropolitano Niguarda

Italy

Leonardo Renieri

Careggi University Hospital of Florence

Largo Brambilla 3
Florence, 50141
Italy

Nicola Limbucci

Careggi University Hospital of Florence

Largo Brambilla 3
Florence, 50141
Italy

Mario Martínez-Galdámez

Hospital Clínico de Valladolid

Valladolid
Spain

Miguel Schüller

Hospital Clínico de Valladolid

Valladolid
Spain

Jorge Galván

Hospital Clínico de Valladolid

Valladolid
Spain

Juan Francisco Arenillas-Lara

University of Valladolid - Department of Neurology

Avenida Ramón y Cajal n° 3
47003 Valladolid
Spain

Zafar Hashim

Government of the United Kingdom - University Hospitals of North Midlands

Stoke-on-Trent
United Kingdom

Sanjeev Nayak

Government of the United Kingdom - University Hospitals of North Midlands

Stoke-on-Trent
United Kingdom

Keith Desousa

Northwell Health

NY
United States

Hai Sun

Rutgers, The State University of New Jersey - New Jersey Medical School

NJ
United States

Pankaj K Agarwalla

Rutgers, The State University of New Jersey - New Jersey Medical School ( email )

NJ
United States

Anil Nanda

Rutgers, The State University of New Jersey - New Jersey Medical School

NJ
United States

Juan Diogo Lonzano

Riverside Community Hospital

Riverside, CA
United States

Sudipta Roychoudhury

Robert Wood Johnson University Hospital ( email )

Rutgers, NJ
United States

Emad Nourollahzadeh

Robert Wood Johnson University Hospital

Rutgers, NJ
United States

Chirag D. Gandhi

New York Medical College - Department of Neurology, Radiology and Neurosurgery

Valhalla, NY
United States

Andrew R. Xavier

Riverside Community Hospital

Riverside, CA
United States

Tannavi Prakash

Rutgers, The State University of New Jersey - New Jersey Medical School ( email )

NJ
United States

Gaurav Gupta

Rutgers, The State University of New Jersey - New Jersey Medical School

NJ
United States

Dileep Yavagal

University of Miami - Department of Neurology and Neurosurgery ( email )

Miami, FL 33136
United States

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