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Ischaemic strokes associated with COVID-19: is there a specific pattern?
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  1. Edouard Januel1,
  2. Laure Bottin1,
  3. Marion Yger1,
  4. Anne Leger2,
  5. Sophie Crozier2,
  6. Flore Baronnet2,
  7. Sandrine Deltour2,
  8. Stephen Delorme1,
  9. Jean Capron1,
  10. Alaina Borden3,
  11. Beatrice Marro4,
  12. Frédéric Clarençon5,
  13. Nader Antoine Sourour5,
  14. Yves Samson2,6,
  15. Charlotte Rosso2,6,
  16. Sonia Alamowitch1,7
  1. 1AP-HP, Service de Neurologie et Urgences Neuro-vasculaires, Hopital Saint-Antoine, Sorbonne Université, Paris, Île-de-France, France
  2. 2AP-HP, Urgences Cérébro-Vasculaires, Hôpital Universitaire Pitié Salpêtrière, Sorbonne Université, Paris, Île-de-France, France
  3. 3AP-HP, Service de Neurophysiologie, Hôpital Universitaire Pitié Salpêtrière, Sorbonne Université, Paris, Île-de-France, France
  4. 4AP-HP, Service de Radiologie, Hopital Saint-Antoine, Sorbonne Université, Paris, Île-de-France, France
  5. 5AP-HP, Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
  6. 6Sorbonne Université, Institut du Cerveau et de la Moelle épinière, ICM, INSERM U 1127, CNRS UMR 7225, infrastructure stroke network, STAR team, F-75013, Institut du Cerveau et de la Moelle Épinière, Paris, Île-de-France, France
  7. 7Sorbonne Université, UMRS 938, CdR Saint-Antoine, Hôpital Saint-Antoine, INSERM, Paris, Île-de-France, France
  1. Correspondence to Professor Sonia Alamowitch, AP-HP, Service de Neurologie et Urgences Neuro-vasculaires, Hôpital Saint-Antoine, F-75012, Hopital Saint-Antoine, Paris, Île-de-France, France; sonia.alamowitch{at}aphp.fr

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Introduction

SARS-Cov2 is responsible for COVID-19 that can cause severe respiratory illness, and which can be associated with ischaemic stroke (IS).1 The objectives of our comparative cross-sectional study were to describe the characteristics of consecutive patients with IS and COVID-19, to compare them to COVID-19-negative IS patients admitted within the same period and to attempt to identify a specific pattern of IS in COVID-19.

Methods

We conducted a comparative cross-sectional study at two tertiary stroke units, Pitié-Salpêtrière and Saint-Antoine Hospitals, between March 20 and April 20 2020. Cases and controls were all consecutive adult patients hospitalised for recent IS, confirmed on neuroimaging. Cases were diagnosed with COVID-19 if a nasopharyngeal reverse transcription (RT-PCR) test for SARS-CoV-2 (Allplex 2019-nCoV Assay, Seegene) was positive and/or if a chest CT-scan was typical for COVID-19. Exclusion criteria were diagnoses of transient ischaemic attack, haemorrhagic stroke or stroke secondary to cerebral venous thrombosis.

We collected demographic data, cardiovascular risk factors, neurological data, blood test results, in-hospital treatments and discharge outcomes. After reviewing the available workup for each patient (vascular imaging of cerebral and cervical arteries and cardiac evaluation including a 12-lead ECG, 48 hours continuous ECG monitoring and transthoracic echocardiogram), aetiology of IS was classified according to ASCODphenotyping (A: atherosclerosis; S: small-vessel disease; C: cardiac pathology; O: other causes; D: dissection).

Fisher’s exact test and Wilcoxon-Mann-Whitney test were used to compare cases and controls for categorical and continuous variables respectively. P­ values <0.05 defined statistical significance. All data analyses were conducted using Stata V.14.0.

Results

Between March 20 and April 20 2020, 67 patients with IS were hospitalised (41 at Pitié-Salpêtrière and 26 at Saint-Antoine Hospital). Among them, 12 (17.9%) were infected with SARS Cov-2. Patient characteristics are detailed in table 1.

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Table 1

Characteristics of patients hospitalised for ischaemic stroke with COVID-19 versus ischaemic stroke without COVID-19 …

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