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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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Characteristics of patients hospitalised for ischaemic stroke with COVID-19 versus ischaemic stroke without COVID-19 …
Footnotes
EJ, LB, MY, CR and SA contributed equally.
Contributors EJ, LB and MY were responsible for data acquisition, analysis and interpretation and drafting of the manuscript. EJ was responsible for statistical analysis. LB was responsible for imaging draft. SA and CR were responsible for study conception, design, supervision, analysis and interpretation of data, and drafting of the manuscript. All other authors were responsible for acquisition of data and for revision of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests EJ reports reimbursement for conference registration fees, travel expenses and accommodation from Sanofi Genzyme, outside the submitted work. LB reports reimbursement for conference registration fees, travel expenses and accommodation from Pfizer and reimbursement for conference registration fees from Boehringer Ingelheim, outside the submitted work. MY reports reimbursement for conference registration fees from Pfizer and Boehringer Ingelheim, outside the submitted work. JC reports payment for consultancy and readings from Eisai, outside the submitted work; reimbursement for conference registration fees, travel expenses and accommodation from Pfizer SAS, noutside the submitted work. FC reports payment for readings from Medtronic, Guerbet, Balt Extrusion, Penumbra, outside the submitted work; and conflict of interest with Codman Neurovascular and Microvention (core lab; outside the submitted work). NAS reports payment for consultancy from Medtronic, Balt Extrusion, Microvention, outside the submitted work. SA reports payment for consultancy and readings from Astra Zeneca, outside the submitted work; payment for readings from Bayer and BMS-Pfizer, outside the submitted work; and is associate editor of Revue Neurologique.
Patient consent for publication Not required.
Ethics approval This study was approved by the Research Ethics Committee of Sorbonne University (CER-2020–41).
Provenance and peer review Not commissioned; externally peer reviewed.
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