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SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group.
Shahjouei, Shima; Anyaehie, Michelle; Koza, Eric; Tsivgoulis, Georgios; Naderi, Soheil; Mowla, Ashkan; Avula, Venkatesh; Vafaei Sadr, Alireza; Chaudhary, Durgesh; Farahmand, Ghasem; Griessenauer, Christoph; Azarpazhooh, Mahmoud Reza; Misra, Debdipto; Li, Jiang; Abedi, Vida; Zand, Ramin.
  • Shahjouei S; Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA.
  • Anyaehie M; Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA.
  • Koza E; Neuroscience Institute, Geisinger Commonwealth School of Medicine, Scranton, PA 18510, USA.
  • Tsivgoulis G; Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, School of Medicine, 12462 Athens, Greece.
  • Naderi S; Department of Neurosurgery, Tehran University of Medical Sciences, Tehran 14155-6559, Iran.
  • Mowla A; Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA.
  • Avula V; Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
  • Vafaei Sadr A; Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA.
  • Chaudhary D; Department de Physique Theorique and Center for Astroparticle Physics, University Geneva, 1211 Geneva, Switzerland.
  • Farahmand G; Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA.
  • Griessenauer C; Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran 14155-6559, Iran.
  • Azarpazhooh MR; Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA.
  • Misra D; Research Institute of Neurointervention, Paracelsus Medical University, 5020 Salzburg, Austria.
  • Li J; Department of Clinical Neurological Sciences, Western University, London, ON N6A 3K7, Canada.
  • Abedi V; Steele Institute of Health and Innovation, Geisinger Health System, Danville, PA 17822, USA.
  • Zand R; Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA 17822, USA.
  • The Multinational Covid-Stroke Study Group; Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA 17822, USA.
J Clin Med ; 10(5)2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1124907
Semantic information from SemMedBD (by NLM)
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Subject
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2. Cerebrovascular accident PROCESS_OF Patients
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3. Acute Ischemic Stroke PROCESS_OF Patients
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Acute Ischemic Stroke
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4. Vascular occlusion PROCESS_OF Patients
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5. Embolic Stroke PROCESS_OF Patients
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6. Arteries LOCATION_OF Arteriosclerosis
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7. Arteriosclerosis PROCESS_OF Patients
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8. Cardioembolic Stroke COEXISTS_WITH Neoplasms
Subject
Cardioembolic Stroke
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13. Embolic Stroke PROCESS_OF Patients
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ABSTRACT

BACKGROUND:

SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investigated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic.

METHODS:

This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addition, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S).

RESULTS:

This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K 36% and ML-S 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K 59% and ML-S 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K 83% and ML-S 85%) and had about 50% risk of large vessel occlusions (ML-K 50% and ML-S 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K 30% and ML-S 43% of patients) and cardioembolic strokes (ML-K 34% and ML-S 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6-14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8-40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4-36.2) were associated with cardioembolic stroke.

CONCLUSIONS:

Although a cohort of young and healthy men with cardioembolic and large vessel occlusions can be distinguished using both clinical sub-grouping and unsupervised clustering, stroke in other patients may be explained based on the existing comorbidities.
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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Type of study: Observational study / Prognostic study / Risk factors Language: English Clinical aspect: Etiology Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Type of study: Observational study / Prognostic study / Risk factors Language: English Clinical aspect: Etiology Year: 2021
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