COVID Stroke: Rate, Type, Disparity

Large study reported in American Stroke Association virtual International Stroke Conference (ISC) We focused on a more accurate estimation of the stroke effects of COVID-19.

The overall incidence of ischemic stroke in COVID-19 patients in the American Heart Association (AHA) COVID-19 registry was 0.75%, said Dr. Saate Shakil of the University of Washington, Seattle.

The rate was lower than the 0.9% to 2% reported in other stroke studies in COVID-19 patients, she said during the ISC’s latest trial session.

However, she pointed out that the series was much larger than previous studies, which exceeded about 8,000 patients.

Another factor was that registry data was extended from March to November 2020, and the data tended to have more strokes than late at the peak of the spring pandemic, Shakil said. Today’s MedPage At a press conference.

The study included 21,073 inpatients with SARS-CoV-2 with race or ethnic information, out of a total of more than 31,000 registered in the AHACOVID-19 CVD registry as part of the “Get With the Guidelines” database. Was included. ..

In another international study of 6,698 COVID-19 patients admitted to nine stroke centers, the incidence of stroke was 1.3%. Of those 88 cases, 60% (53) had large vessel occlusion (LVO).

While Dominance of macrovascular attacks Dileep R at the University of Miami. Yavagal, MD and MBBS have been reported before, but this large series has confirmed it. Today’s MedPage..His group reported the findings at the ISC Online Neurosurgery..

The retrospective study included consecutive patients at 12 stroke centers in 4 countries who were hospitalized for acute ischemic stroke and COVID-19 from March 1 to May 1, 2020, but 3 One center accepted only LVO transfers and was therefore excluded from the stroke incidence calculation. patient.

Macrovascular occlusion is also more pronounced in another analysis of the “Get With the Guidelines-Stroke” database, accounting for 30.4% of acute ischemic strokes in COVID-19 patients and 23.6% in non-COVID stroke patients. ..

An analysis of 41,971 acute ischemic stroke patients (1,143 with COVID-19) admitted to 458 participating hospitals between February 4 and June 29, 2020, was analyzed by Greg Phonaro of the University of California, Los Angeles. Reported by Doctor of Medicine and ISC colleagues.And Online stroke..

Notable in the findings was the significantly longer delays in treatment, despite similar rates of thrombolytic therapy and thrombectomy.

• Door to CT: Median 55:35
• Door to the needle: 59:46 minutes
• Door to endovascular treatment: 114: 90 minutes

Yabagar said this was consistent with his experience. “Looking at our own center data, COVID-positive patients are late due to PPE. [personal protective equipment] “The problem ranges from about 10 to 20 minutes, and thankfully it’s not that big, but it’s a problem in stroke because those neurons are dead,” he said.

The result also got worse For COVID-19 patients, as previously seen in a small study. Discharges with a modified Rankin scale score of 2 or less were 35% less likely, and in-hospital mortality was more than four-fold higher than in other stroke patients.

In Shakil’s study, COVID-19 patients were twice as likely to require ICU care or die, and were twice as long as other ischemic stroke patients.

All three studies showed an imbalanced burden of stroke or LVO in COVID-19 in non-Hispanic black patients.

While Fonarow’s analysis showed that patients of Hispanic and Asian descent were also at high risk, Shakil’s study found that patients of Hispanic descent were actually at low risk. Co-author Mitchell Elkind, MD, of AHA, suggested that the timing of the study could play a role as different regions of countries with different demographics were more seriously affected, but why did it happen? She said it wasn’t clear. Early and late pandemics.

These studies show a number of strengths, commented Louise McCullough, MD, PhD, ISC Chairman of the University of Texas Health Science Center for Houston.

She also gave a big picture of how infections more commonly affect the risk of stroke.

“We are seeing the direct impact of COVID,” she said. But the question is, for the millions of people who have recovered from it, what are the long-term consequences for recurring events, dementia, and other neurological problems over the next few decades. Such datasets can help answer these questions, she said. “Even if COVID disappears completely next year, it will never disappear because the number of people who have been touched and affected is so large.”

Although some effort was required to update the data form, Elkind stated that data on COVID-19 vaccination is in the AHA registry to further investigate its impact on stroke and other clinical problems. It was.