Download PDF
CC BY 4.0 · The Arab Journal of Interventional Radiology 2024; 08(01): 013-018
DOI: 10.1055/s-0043-1775991
Original Article

CT and Angiographic Findings among COVID-19-Positive Patients Presenting with Stroke and Their Outcomes

Noor Badrawi 
1   Dubai Academic Health Corporation, Dubai, United Arab Emirates
,
Noon Elawad 
1   Dubai Academic Health Corporation, Dubai, United Arab Emirates
,
Amritendu Mukherjee
2   Rashid Hospital, Dubai Academic Health Corporation, Dubai, United Arab Emirates
,
Ahmad Abdel Muhdi
2   Rashid Hospital, Dubai Academic Health Corporation, Dubai, United Arab Emirates
,
Ayman Al-Sibaie
2   Rashid Hospital, Dubai Academic Health Corporation, Dubai, United Arab Emirates
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background The study aims to assess and compare the computed tomographic and angiographic findings and clinical outcomes among coronavirus disease 2019 (COVID-19)-positive and COVID-19-negative patients.

Methods We conducted a retrospective study of all patients presenting with acute stroke to our facility between March 2020 and October 2021. Demographics, risk factors, COVID-19 status, National Institute of Health Stroke Scale (NIHSS), mode of treatment, length of hospital stay, imaging findings, and angiographic and clinical outcomes were extracted from electronic medical records. Descriptive statistics were used to summarize the data. Pregnant patients, those under the age of 18, and those found to have an alternative diagnosis were excluded. We identified 103 patients with acute stroke who underwent thrombolysis and/or mechanical thrombectomy, 16 of whom were found to be COVID-positive (study group), while 87 of them had negative status (control group).

Results The mean age of both groups (COVID-19 positive and COVID-19 negative) was 56 years, and 85% were male. The most frequently involved vessel was the M1 segment of the middle cerebral artery (37% in COVID-19-positive patients vs. 41% in COVID-19-negative patients). Sixty-one patients underwent thrombectomy, and both groups had comparable successful recanalization. Patients with COVID-19 infection were more likely to have a more extended hospital stay and a higher average NIHSS score at discharge.

Conclusion Our study shows that ischemic stroke in COVID-19 occurs in predominantly male patients, with the middle cerebral artery being the most frequently involved vascular territory. Furthermore, there is a longer hospital stay and worse morbidity regardless of the mode of treatment and imaging findings in COVID-19-positive patients.

Keywords

COVID-19 - stroke - imaging - angiography - ischemic stroke - large vessel occlusion - thrombectomy


Publication History

Article published online:
13 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Hernández-Fernández F, Sandoval Valencia H, Barbella-Aponte RA. et al. Cerebrovascular disease in patients with COVID-19: neuroimaging, histological and clinical description. Brain 2020; 143 (10) 3089-3103
    CrossrefPubMedGoogle Scholar
  • 2 Morassi M, Bagatto D, Cobelli M. et al. Stroke in patients with SARS-CoV-2 infection: case series. J Neurol 2020; 267 (08) 2185-2192
    CrossrefPubMedGoogle Scholar
  • 3 Beyrouti R, Adams ME, Benjamin L. et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry 2020; 91 (08) 889-891
    CrossrefPubMedGoogle Scholar
  • 4 Oxley TJ, Mocco J, Majidi S. et al. Large-vessel stroke as a presenting feature of COVID-19 in the young. N Engl J Med 2020; 382 (20) e60
    CrossrefPubMedGoogle Scholar
  • 5 Filatov A, Sharma P, Hindi F, Espinosa PS. Neurological complications of coronavirus disease (COVID-19): encephalopathy. Cureus 2020; 12 (03) e7352
    PubMedGoogle Scholar
  • 6 Siegler JE, Cardona P, Arenillas JF. et al. Cerebrovascular events and outcomes in hospitalized patients with COVID-19: the SVIN COVID-19 multinational registry. Int J Stroke 2021; 16 (04) 437-447
    CrossrefPubMedGoogle Scholar
  • 7 Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020; 135 (23) 2033-2040
    CrossrefPubMedGoogle Scholar
  • 8 Vogrig A, Gigli GL, Bnà C, Morassi M. Stroke in patients with COVID-19: clinical and neuroimaging characteristics. Neurosci Lett 2021; 743: 135564
    CrossrefPubMedGoogle Scholar
  • 9 Papanagiotou P, Ntaios G. Endovascular thrombectomy in acute ischemic stroke. Circ Cardiovasc Interv 2018; 11 (01) e005362
    CrossrefPubMedGoogle Scholar
  • 10 Powers WJ, Rabinstein AA, Ackerson T. et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 2019; 50 (12) e344-e418
    CrossrefPubMedGoogle Scholar
  • 11 Al Kasab S, Almallouhi E, Alawieh A. et al; STAR collaborators. International experience of mechanical thrombectomy during the COVID-19 pandemic: insights from STAR and ENRG. J Neurointerv Surg 2020; 12 (11) 1039-1044
    CrossrefPubMedGoogle Scholar
  • 12 Pop R, Hasiu A, Bolognini F. et al. Stroke thrombectomy in patients with COVID-19: initial experience in 13 cases. AJNR Am J Neuroradiol 2020; 41 (11) 2012-2016
    CrossrefPubMedGoogle Scholar
  • 13 Li Y, Wang M, Zhou Y. et al. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study. MedRxiv 2004; DOI: 10.1101/2020.02.22.20026500. 2020.02.22.20026500
    CrossrefGoogle Scholar
  • 14 He Q, Wu C, Luo H. et al. Trends in in-hospital mortality among patients with stroke in China. PLoS One 2014; 9 (03) e92763
    CrossrefPubMedGoogle Scholar
  • 15 Wang A, Mandigo GK, Yim PD, Meyers PM, Lavine SD. Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics. J Neurointerv Surg 2020; 12 (07) 648-653
    CrossrefPubMedGoogle Scholar
  • 16 Kaki A, Singh H, Cohen G, Schreiber T. A case report of a large intracardiac thrombus in a COVID-19 patient managed with percutaneous thrombectomy and right ventricular mechanical circulatory support. Eur Heart J Case Rep 2020; 4 (06) 1-5
    CrossrefPubMedGoogle Scholar
  • 17 Mosconi MG, Paciaroni M. Treatments in ischemic stroke: current and future. Eur Neurol 2022; 85 (05) 349-366
    CrossrefPubMedGoogle Scholar
  • 18 Boira I, Esteban V, Vañes S, Castelló C, Celis C, Chiner E. Major bleeding complications in COVID-19 patients. Cureus 2021; 13 (08) e16816
    PubMedGoogle Scholar
  • 19 Richter D, Krogias C, Eyding J, Bartig D, Grau A, Weber R. Comparison of stroke care parameters in acute ischemic stroke patients with and without concurrent Covid-19. A nationwide analysis. Neurol Res Pract 2020; 2: 48
    CrossrefPubMedGoogle Scholar
  • 20 Kojundžić SL, Sablić S, Budimir Mršić D. et al. Mechanical thrombectomy in acute ischemic stroke COVID-19 and non-COVID-19 patients: a single comprehensive stroke center study. Life (Basel) 2023; 13 (01) 186
    PubMedGoogle Scholar
  • 21 Kihira S, Schefflein J, Mahmoudi K. et al. Association of coronavirus disease (COVID-19) with large vessel occlusion strokes: a case-control study. AJR Am J Roentgenol 2021; 216 (01) 150-156
    CrossrefPubMedGoogle Scholar