Incidence, Characteristics and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study

Abstract

Background: While there are reports of acute ischemic stroke (AIS) in coronavirus disease 2019 (COVID-19) patients, the overall incidence of AIS and clinical characteristics of large vessel occlusion (LVO) remain unclear.

Objective: To attempt to establish incidence of AIS in COVID-19 patients in an international cohort.

Methods: A cross-sectional retrospective, multicenter study of consecutive patients admitted with AIS and COVID-19 was undertaken from March 1 to May 1, 2020 at 12 stroke centers from 4 countries. Out of those 12 centers, 9 centers admitted all types of strokes and data from those were used to calculate the incidence rate of AIS. Three centers exclusively transferred LVO stroke (LVOs) patients and were excluded only for the purposes of calculating the incidence of AIS. Detailed data were collected on consecutive LVOs in hospitalized patients who underwent mechanical thrombectomy (MT) across all 12 centers.

Results: Out of 6698 COVID-19 patients admitted to 9 stroke centers, the incidence of stroke was found to be 1.3% (interquartile range [IQR] 0.75%-1.7%). The median age of LVOs patients was 51 yr (IQR 50-75 yr), and in the US centers, African Americans comprised 28% of patients. Out of 66 LVOs, 10 patients (16%) were less than 50 yr of age. Among the LVOs eligible for MT, the average time from symptom onset to presentation was 558 min (IQR 82-695 min). A total of 21 (50%) patients were either discharged to home or discharged to acute rehabilitation facilities.

Conclusion: LVO was predominant in patients with AIS and COVID-19 across 2 continents, occurring at a significantly younger age and affecting African Americans disproportionately in the USA.

Keywords: Acute ischemic stroke; COVID-19; Epidemiology; Large vessel occlusion.

Graphical Abstract

FIGURE 1.

X-axis shows the name of the hospital and total number of COVID admissions during the study period. Y-axis shows the number of AIS (blue bar), LVOs (red bar), and incidence of AIS in COVID-19 (%) (green bar) admitted patients. (1) UH, NJ, USA, stands for University Hospital, New Jersey Medical School, Rutgers, New Jersey, USA; (2) RWJ, NJ, USA stands for Robert Wood Johnson Hospital & Medical School, Rutgers, New Jersey, USA; (3) WMC, NY, US stands for Westchester Medical Center at NY Medical College, Valhalla, New York, USA; (4) BK/NYU, NY, USA stands for Brookdale Hospital Center, NYU School of Medicine, New York City, USA; (5) NH, NY, USA Eastern Region, Northwell Health, Long Island, New York, USA; (6) SJH, DMC stands for Michigan, Saint Joseph Health, Detroit Medical Center, Michigan, USA; (7) RCH, CA stands for University of California Riverside, Riverside Community Hospital, California, USA; (8) CU stands for Careggi University, Florence, Italy, and GOMN stands for Grande Ospedale Metropolitano Niguarda, Milan. Italy; (9) U of V stands for Hospital Clínico Universitario de Valladolid, Spain; and (10) RSUH, UK stands for Royal Stoke University Hospital, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom. LVOs is large vessel occlusion stroke; AIS is acute ischemic stroke.

FIGURE 2.

Breakdown of disposition of strokes due to large vessel occlusion (LVO) in COVID-19 admitted patients. Noneligible denotes nonreceipt of EVT by accepted LVO trial criteria. Unstable denotes medically unfit to undergo the procedure.