By Matthew E. Fink, MD

Louis and Gertrude Feil Professor and Chair, Department of Neurology, Associate Dean for Clinical Affairs, NYP/Weill Cornell Medical College

SOURCE: Srivastava PK, Zhang S, Xian Y, et al. Acute ischemic stroke in patients with COVID-19. An analysis from Get With The Guidelines–Stroke. Stroke 2021;52:1826-1829.

Since the first cases of COVID-19 were reported in the United States, severe ischemic strokes also have been reported in some of these patients, some with large vessel occlusions and case reports of thrombectomy for treatment. Get With The Guidelines-Stroke is the largest national stroke registry that has been collecting data at 2,000 U.S. hospitals for many years. Srivastava et al queried the database to assess the frequency, risk factors, and severity of acute ischemic stroke (AIS) in COVID-19 patients across the country. From Feb. 4, 2020, until June 29, 2020, they identified 41,971 patients with AIS and identified 1,143 who had AIS in the setting of COVID-19 infection. They compared them with AIS patients who did not have COVID-19. Patients who had both AIS and COVID-19 were younger, or likely to be Black, Hispanic, or Asian rather than white, or more likely to have a higher National Institutes of Health Stroke Scale score, and a higher proportion had large vessel occlusions. Door-to-CT time, door-to-needle time for thrombolysis, and/or to endovascular therapy times were longer in the AIS/COVID-19 cohort compared to the control group.

In a risk-adjusted model, patients who had AIS/COVID-19 had decreased odds ratio of discharge with the modified Rankin Scale score ≤ 2 and had an increased risk of in-hospital mortality. Patients with ischemic stroke in the setting of COVID-19 were younger, had greater stroke severity, waited longer for evaluation and treatment, and experienced worse morbidity and mortality compared to those without COVID-19.