DG Alerts Anesthesiology
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, suggests a study published in the American Journal of Roentgenology.
“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, and colleagues.
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 3 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.
Further, the most commonly observed LVO was middle cerebral artery segment M1-M2 occlusion, which occurred in 44 (62%) patients, while multifocal LVOs were observed in 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). The authors noted no other stroke-related risk factor was associated with LVO in the multivariate analysis.
“Patients with active SARS-CoV-2 infection should be monitored closely, especially if they present with acute neurologic symptoms, with a lower threshold of suspicion of LVOs,” the authors emphasised.
“Health care providers in the emergency department and inpatient areas should be cognizant of this association and not delay activating a stroke code. This association may aid neurointerventionalists assessing the presence and location of an LVO if they are aware of this elevated risk in the COVID-19 population,” the authors added, noting that this association may “imply that patients with LVO during the COVID-19 pandemic who have not undergone testing for SARS-CoV-2 infection or are waiting for results warrant higher suspicion and appropriate precautions.”
“Future investigation may focus on the exact pathophysiologic mechanism of large vessel strokes in patients with COVID-19 and validate contributing risk factors through a larger study,” the authors noted.