Ischemic stroke in COVID-19 patients: Mechanisms, treatment, and outcomes in a consecutive Swiss Stroke Registry analysis
Journal Paper/Review - Dec 9, 2021
Strambo Davide, Lindheimer Florian, Baumgärtner Markus, Schelosky Ludwig, Bonvin Christophe, Mono Marie-Luise, Rodic Biljana, von Reding Andrea, Schwegler Guido, Massini Federico, Tarnutzer Alexander A, Taheri Shadi, Peters Nils, Beyeler Morin, Altersberger Valerian, Engelter Stefan T, Fischer Urs, Michel Patrik, Berger Christian, Medlin Friedrich, De Marchis Gian Marco, Bonati Leo H, Arnold Marcel, Carrera Emmanuel, Galletta Santi, Nedeltchev Krassen, Kahles Timo, Cereda Carlo W, Bianco Giovanni, Kägi Georg, Luft Andreas R, Bolognese Manuel, Lakatos Lehel-Barna, Salmen Stephan, Correia Pamela, Sturzenegger Rolf, Albert Sylvan, Swiss Stroke Registry Investigators
Most case series of patients with ischemic stroke (IS) and COVID-19 are limited to selected centers or lack 3-month outcomes. The aim of this study was to describe the frequency, clinical and radiological features, and 3-month outcomes of patients with IS and COVID-19 in a nationwide stroke registry.
From the Swiss Stroke Registry (SSR), we included all consecutive IS patients ≥18 years admitted to Swiss Stroke Centers or Stroke Units during the first wave of COVID-19 (25 February to 8 June 2020). We compared baseline features, etiology, and 3-month outcome of SARS-CoV-2 polymerase chain reaction-positive (PCR+) IS patients to SARS-CoV-2 PCR- and/or asymptomatic non-tested IS patients.
Of the 2341 IS patients registered in the SSR during the study period, 36 (1.5%) had confirmed COVID-19 infection, of which 33 were within 1 month before or after stroke onset. In multivariate analysis, COVID+ patients had more lesions in multiple vascular territories (OR 2.35, 95% CI 1.08-5.14, p = 0.032) and fewer cryptogenic strokes (OR 0.37, 95% CI 0.14-0.99, p = 0.049). COVID-19 was judged the likely principal cause of stroke in 8 patients (24%), a contributing/triggering factor in 12 (36%), and likely not contributing to stroke in 13 patients (40%). There was a strong trend towards worse functional outcome in COVID+ patients after propensity score (PS) adjustment for age, stroke severity, and revascularization treatments (PS-adjusted common OR for shift towards higher modified Rankin Scale (mRS) = 1.85, 95% CI 0.96-3.58, p = 0.07).
In this nationwide analysis of consecutive ischemic strokes, concomitant COVID-19 was relatively rare. COVID+ patients more often had multi-territory stroke and less often cryptogenic stroke, and their 3-month functional outcome tended to be worse.