Patients With COVID-19 and Stroke Are Younger With Worse Severity and Outcomes

Author(s):

Researchers conducted a systematic review of studies reporting on patients with both COVID-19 and stroke and found worse outcomes compared to patients with stroke alone.

Olav Jansen, Dr Med

Data from a recent study suggest that patients with stroke and COVID-19 were younger than typical stroke patients, with greater stroke severity and worse outcomes after mechanical thrombectomy (MT).¹

These findings were presented at the American Stroke Association’s (ASA) International Stroke Conference (ISC) 2021, March 17-19. Olav Jansen, Dr Med, professor and academic director, Department of Radiology and Neuroradiology, Christian-Albrechts-Universität zu Kiel, served as senior author on the study.

“The pandemic with SARS-CoV2 is ongoing and cases are surging in a number of countries. Stroke as a prevalent neurological manifestation of CoViD-19 as a result of systemic inflammatory or hypercoagulatory state has been reported. Since mechanical thrombectomy is the single most effective therapy for stroke with large vessel occlusion we aimed to perform a systematic literature review,” Jansen and colleagues wrote in the abstract.

Jansen and colleagues performed a systematic literature search on PubMed and identified studies that reported on patients with COVID-19 and stroke treated with MT through October 2020 that reported demographics, clinical parameters, imaging characteristics, outcome results, and COVID-19 specifics.

Altogether, they analyzed data from 12 studies with a total of 98 patients (range, 2-17), most of which were conducted in the US (n = 8). Around half (n = 54; 59%) of patients were male and median National Institutes of Health Stroke Scale (NIHSS) scores ranged from 12 to 22. Patients with COVID-19 and stroke were younger than non-COVID-19 patients with stroke. Neurological symptoms as a first manifestation of COVID-19 were reported in 28 cases (48%), with the primary motor cortex (M1; n = 47) and internal carotid artery (ICA; n = 15) most affected.

Intravenous recombinant tissue plasminogen activator (IV rtPA) was administered in 40 cases (50%), with median onset-to-groin time ranging from 222.5 to 259 minutes. Thrombolysis in cerebral infarction (TICI) score of at least 2b was achieved in 82 cases (87%). Jansen and colleagues found a trend of unfavorable neurological outcomes, with a mortality rate of 35% (32 cases). Six studies analyzed included a control group; together these studies suggest that patients with stroke and COVID-19 had higher NIHSS scores at presentation, worse neurological outcomes, and higher mortality when compared to non-COVID-19 patients with stroke.

“Patients with stroke and CoViD-19 were younger, had more severe neurological deficits at presentation, an unfavorable neurological outcome and high mortality despite prompt and technical successful recanalization. More systematic reporting on treated patients is needed,” Jansen and colleagues concluded.

NeurologyLive has previously reported on associations between COVID-19 diagnosis and stroke outcomes, with 1 such study by David Werring, PhD, professor and consultant neurologist, Queen Square Institute of Neurology, University College London (UCL), and National Hospital for Neurology and Neurosurgery, and colleagues.

Werring and colleagues found that having COVID-19 at onset of stroke is associated with more than twice the rate of mortality of other patients with stroke and worse outcomes. The study also found that individuals of Asian descent may be at higher risk of COVID-19-associated strokes than other groups.²

In this study, researchers found that those with ischemic stroke and COVID-19 were more likely to have multiple large vessel occlusions (17.9% vs 8.1%; P <.03) and had more severe strokes (median National Institutes of Health Stroke Scale [NIHSS] score, 8 vs 5; P <.002) than patients with ischemic stroke alone. Fatalities occurred in 19.8% of ischemic strokes among patients with COVID-19 compared to 9.6% of patients in the control group (P <.00003).

"Our findings suggest that in some people, COVID-19 may influence stroke risk through its effect on excessive blood clotting or inflammation and may also influence the characteristics and outcome of the stroke, including greater severity with a higher chance of multiple large vessel blood clots,” Werring said in a statement.³

For more coverage of ISC 2021, click here.

REFERENCES

1. Jensen-Kondering U, Huhndorf M, Jansen O. Neurothrombectomy in patients with Covid-19. A systematic review and meta-analysis. Presented at International Stroke Conference; March 17–19. Abstract LB P8
2. Perry RJ, Smith CJ, Roffe C, et al. Characteristics and outcomes of COVID-19-associated stroke: a UK multicentre case-control study. J Neurol Neurosurg Psychiatry. 2021;92:242-248. doi: 10.1136/jnnp-2020-324927
3. COVID-19 linked to worse stroke outcomes. News release. University College London. November 5, 2020. Accessed March 29, 2021. https://www.eurekalert.org/pub_releases/2020-11/ucl-clt110520.php