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Scientific article
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Ischemic stroke in COVID-19 patients: Mechanisms, treatment, and outcomes in a consecutive Swiss Stroke Registry analysis

Published inEuropean journal of neurology, vol. 29, no. 3, p. 732-743
Publication date2022-03
First online date2021-12-09
Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

eng
Keywords
  • COVID-19
  • SARS-CoV-2
  • Ischemic stroke
  • COVID-19
  • Humans
  • Ischemic Stroke
  • Registries
  • SARS-CoV-2
  • Stroke / epidemiology
  • Stroke / therapy
  • Switzerland / epidemiology
  • Treatment Outcome
Citation (ISO format)
STRAMBO, Davide et al. Ischemic stroke in COVID-19 patients: Mechanisms, treatment, and outcomes in a consecutive Swiss Stroke Registry analysis. In: European journal of neurology, 2022, vol. 29, n° 3, p. 732–743. doi: 10.1111/ene.15199
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Identifiers
ISSN of the journal1351-5101
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Technical informations

Creation08/05/2022 5:15:00 PM
First validation08/05/2022 5:15:00 PM
Update time03/16/2023 9:05:14 AM
Status update03/16/2023 9:05:11 AM
Last indexation02/12/2024 1:44:36 PM
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