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Characteristics of Large-Vessel Occlusion Associated with COVID-19 and Ischemic Stroke.
AJNR Am J Neuroradiol. 2020 Aug 27 [Online ahead of print]AA

Abstract

The mechanisms and phenotype of ischemic stroke associated with coronavirus disease 2019 (COVID-19) remain uncertain. A retrospective study was conducted in patients with COVID-19 presenting with ischemic stroke from March 1 to May 25, 2020, and cases with large-vessel occlusion were identified. To provide baseline institutional stroke data within and outside the COVID-19 pandemic, all consecutive ischemic stroke and TIA admissions (COVID and non-COVID) to the hospital during a 10-week period from March 1 to May 10, 2020, were collected and compared with data from the same time period in 2019. Among 20 patients with COVID-19 and acute ischemic stroke, 15 (75%) had large-vessel occlusion. These patients were young (mean age, 46.5 years), male (93%), without major burden of traditional cardiovascular risk factors, and had a severe stroke presentation. Large-vessel occlusions were observed in multiple vessels (40%), uncommonly affected vessels, and atypical locations with a large thrombus burden. Systemic thrombosis separate from large-vessel occlusion was not uncommon (26%). At short-term follow-up, stroke etiology remained undetermined in 46% of patients and functional outcome was poor. The above findings raise the possibility of stroke related to mechanisms induced by the COVID-19 infection itself, including a hypercoagulable state and/or endothelial damage. In addition, they document the severe presentation and poor outcomes of large-vessel occlusion in COVID-19 ischemic stroke.

Authors+Show Affiliations

Department of Neurology (S.J., P.K., V.A.M., B.P.-J., S.I.H.), Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates johns5@clevelandclinicabudhabi.ae. Neurointerventional Surgery (S.J., M.S.E., K.Z.), Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.Department of Neurology (S.J., P.K., V.A.M., B.P.-J., S.I.H.), Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.Department of Neurology (S.J., P.K., V.A.M., B.P.-J., S.I.H.), Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.Department of Neurology (S.J., P.K., V.A.M., B.P.-J., S.I.H.), Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.Neurocritical Care Unit (J.D., A.B., H.E.), Critical Care Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.Neurocritical Care Unit (J.D., A.B., H.E.), Critical Care Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.Neurocritical Care Unit (J.D., A.B., H.E.), Critical Care Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.Department of Neurosurgery, Neurological Institute (F.R., M.S.E.), Cleveland Clinic, Abu Dhabi, United Arab Emirates.Neurointerventional Surgery (S.J., M.S.E., K.Z.), Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates. Department of Neurosurgery, Neurological Institute (F.R., M.S.E.), Cleveland Clinic, Abu Dhabi, United Arab Emirates.Neurointerventional Surgery (S.J., M.S.E., K.Z.), Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.Department of Neurology (S.J., P.K., V.A.M., B.P.-J., S.I.H.), Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32855182

Citation

John, S, et al. "Characteristics of Large-Vessel Occlusion Associated With COVID-19 and Ischemic Stroke." AJNR. American Journal of Neuroradiology, 2020.
John S, Kesav P, Mifsud VA, et al. Characteristics of Large-Vessel Occlusion Associated with COVID-19 and Ischemic Stroke. AJNR Am J Neuroradiol. 2020.
John, S., Kesav, P., Mifsud, V. A., Piechowski-Jozwiak, B., Dibu, J., Bayrlee, A., Elkambergy, H., Roser, F., Elhammady, M. S., Zahra, K., & Hussain, S. I. (2020). Characteristics of Large-Vessel Occlusion Associated with COVID-19 and Ischemic Stroke. AJNR. American Journal of Neuroradiology. https://doi.org/10.3174/ajnr.A6799
John S, et al. Characteristics of Large-Vessel Occlusion Associated With COVID-19 and Ischemic Stroke. AJNR Am J Neuroradiol. 2020 Aug 27; PubMed PMID: 32855182.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics of Large-Vessel Occlusion Associated with COVID-19 and Ischemic Stroke. AU - John,S, AU - Kesav,P, AU - Mifsud,V A, AU - Piechowski-Jozwiak,B, AU - Dibu,J, AU - Bayrlee,A, AU - Elkambergy,H, AU - Roser,F, AU - Elhammady,M S, AU - Zahra,K, AU - Hussain,S I, Y1 - 2020/08/27/ PY - 2020/06/15/received PY - 2020/07/24/accepted PY - 2020/8/29/entrez JF - AJNR. American journal of neuroradiology JO - AJNR Am J Neuroradiol N2 - The mechanisms and phenotype of ischemic stroke associated with coronavirus disease 2019 (COVID-19) remain uncertain. A retrospective study was conducted in patients with COVID-19 presenting with ischemic stroke from March 1 to May 25, 2020, and cases with large-vessel occlusion were identified. To provide baseline institutional stroke data within and outside the COVID-19 pandemic, all consecutive ischemic stroke and TIA admissions (COVID and non-COVID) to the hospital during a 10-week period from March 1 to May 10, 2020, were collected and compared with data from the same time period in 2019. Among 20 patients with COVID-19 and acute ischemic stroke, 15 (75%) had large-vessel occlusion. These patients were young (mean age, 46.5 years), male (93%), without major burden of traditional cardiovascular risk factors, and had a severe stroke presentation. Large-vessel occlusions were observed in multiple vessels (40%), uncommonly affected vessels, and atypical locations with a large thrombus burden. Systemic thrombosis separate from large-vessel occlusion was not uncommon (26%). At short-term follow-up, stroke etiology remained undetermined in 46% of patients and functional outcome was poor. The above findings raise the possibility of stroke related to mechanisms induced by the COVID-19 infection itself, including a hypercoagulable state and/or endothelial damage. In addition, they document the severe presentation and poor outcomes of large-vessel occlusion in COVID-19 ischemic stroke. SN - 1936-959X UR - https://www.unboundmedicine.com/medline/citation/32855182/Characteristics_of_Large_Vessel_Occlusion_Associated_with_COVID_19_and_Ischemic_Stroke_ L2 - http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=32855182 DB - PRIME DP - Unbound Medicine ER -
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