Ischaemic strokes associated with COVID-19: is there a specific pattern?

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. We conducted a comparative cross-sectional study at two tertiary stroke units, Pitie-Salpetriere 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. Between March 20 and April 20 2020, 67 patients with IS were hospitalised (41 at Pitie-Salpetriere and 26 at Saint-Antoine Hospital). Among them, 12 (17.9%) were infected with SARS Cov-2. Patient characteristics are detailed in table 1. View this table: Table 1 Characteristics of patients hospitalised for ischaemic stroke with COVID-19 versus ischaemic stroke without COVID-19 …