Study Shows Association Between COVID-19, Large Vessel Occlusion Strokes

July 31, 2020
Patients with coronavirus disease 2019 (COVID-19) presenting with acute neurologic symptoms warrant a lower threshold for suspicion of large vessel occlusion (LVO) stroke, thus necessitating prompt workup. “To our knowledge, this is the first study to describe an association between COVID-19 and large vessel strokes,” wrote Shingo Kihira, MD, Icahn School of Medicine at Mount Sinai, New York, New York. The retrospective case-control study included 329 patients (53.2% male, mean age 66.9 years) for whom a code for stroke was activated between March 16,2020, and April 30, 2020, at a single system of 6 hospitals across the 5 boroughs of New York City. Demographic data (age, sex, and race or ethnicity), COVID-19 status, stroke-related risk factors, as well as clinical and imaging findings pertaining to stroke were collected from the electronic medical record. Of the patients, 116 (35.3%) had acute ischaemic stroke confirmed with imaging, 71 (21.6%) had LVO stroke, and 48 (14.6%) had small vessel occlusion (SVO) stroke. The most commonly observed LVO [62.0% (44/71)] was middle cerebral artery segment M1-M2 occlusion, which occurred in 44 (62%) patients. Multifocal LVOs were observed in only 7 (9.9%) of patients with LVO stroke. Of the patients, 126 (38.3%) had COVID-19. The remaining 203 patients without COVID-19 formed the negative control group. LVO stroke was present in 31.7% of patients with COVID-19, compared with 15.3% of patients without COVID-19 (P = .001). SVO stroke was present in 15.9% and 13.8%, respectively (P = .632). In multivariate analysis controlled for race and ethnicity, presence of COVID-19 had a significant independent association with LVO stroke compared with absence of COVID-19 (odds ratio = 2.4; P = .011). After stratification for race and ethnicity, the results showed that the risk of large vessel stroke among patients with COVID-19 was 2.4 times as high as that among patients without COVID-19. Reference: https://www.ajronline.org/doi/10.2214/AJR.20.23847 SOURCE: American Roentgen Ray Society