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Association of Coronavirus Disease (COVID-19) With Large Vessel Occlusion Strokes: A Case-Control Study.
AJR Am J Roentgenol. 2020 Jul 29 [Online ahead of print]AA

Abstract

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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.

Authors+Show Affiliations

Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, Box 1234, New York, NY 10029.Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, Box 1234, New York, NY 10029.Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, Box 1234, New York, NY 10029.Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, Box 1234, New York, NY 10029.Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, Box 1234, New York, NY 10029.Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, Box 1234, New York, NY 10029. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY.Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, Box 1234, New York, NY 10029.Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, Box 1234, New York, NY 10029.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32755225

Citation

Kihira, Shingo, et al. "Association of Coronavirus Disease (COVID-19) With Large Vessel Occlusion Strokes: a Case-Control Study." AJR. American Journal of Roentgenology, 2020, pp. 1-6.
Kihira S, Schefflein J, Mahmoudi K, et al. Association of Coronavirus Disease (COVID-19) With Large Vessel Occlusion Strokes: A Case-Control Study. AJR Am J Roentgenol. 2020.
Kihira, S., Schefflein, J., Mahmoudi, K., Rigney, B., N Delman, B., Mocco, J., Doshi, A., & Belani, P. (2020). Association of Coronavirus Disease (COVID-19) With Large Vessel Occlusion Strokes: A Case-Control Study. AJR. American Journal of Roentgenology, 1-6. https://doi.org/10.2214/AJR.20.23847
Kihira S, et al. Association of Coronavirus Disease (COVID-19) With Large Vessel Occlusion Strokes: a Case-Control Study. AJR Am J Roentgenol. 2020 Jul 29;1-6. PubMed PMID: 32755225.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Coronavirus Disease (COVID-19) With Large Vessel Occlusion Strokes: A Case-Control Study. AU - Kihira,Shingo, AU - Schefflein,Javin, AU - Mahmoudi,Keon, AU - Rigney,Brian, AU - N Delman,Bradley, AU - Mocco,J, AU - Doshi,Amish, AU - Belani,Puneet, Y1 - 2020/07/29/ PY - 2020/8/7/entrez KW - COVID-19 KW - coronavirus disease KW - ischemic strokes KW - large vessel strokes SP - 1 EP - 6 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol N2 - To listen to the podcast associated with this article, please select one of the following: iTunes, Google Play, or direct download. 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. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/32755225/Association_of_Coronavirus_Disease__COVID_19__With_Large_Vessel_Occlusion_Strokes:_A_Case_Control_Study_ L2 - https://www.ajronline.org/doi/10.2214/AJR.20.23847 DB - PRIME DP - Unbound Medicine ER -
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