STROKE ETIOLOGIES IN PATIENTS WITH COVID-19

ABSTRACT

Patients with severe COVID-19 may have an increased risk of venous and arterial thrombotic events, including ischemic stroke (IS). It has been hypothesized that the infection by SARS-CoV-2 alone may be a risk factor for IS, particularly in young subjects. Our objective was to compare stroke etiologies in patients with IS, with (ISCOVID+) or without (ISCOVID-) SARS-CoV-2 infection, < or 45 years. Patients ≥ 18 years with IS confirmed by computerized tomography (CT) or magnetic resonance imaging (MRI), consecutively admitted to our institution at two different periods between April and June 2019 (ISCOVID-), and between April and August 2020 (ISCOVID+ and ISCOVID-) were included in an observational single-center cohort. Patients with molecular detection of SARS-CoV-2 before the stroke, or within 15 days after stroke or detection of serum antibodies before or within 30 days after the IS were compared with matching controls. The primary outcome was the stroke etiology according to the Causative Classification System for Ischemic Stroke (CCS) algorithm. In addition, two subgroups were determined for the category of Other uncommon Causes (OC) iatrogenic causes (OC-IC) and Other uncommon Causes excluding iatrogenic (OC-EI). A total of 212 patients were included (160 in ISCOVID+ and 42 in ISCOVID-). Cardio-aortic embolism (CE) was the most common etiology in the two groups. Two patients in the ISCOVID+ group but none in the ISCOVID-group had unexplained thrombosis of the carotid bifurcation. There were independent associations between younger age (RR 0.91, 95% CI 0.87 - 0.95) as well as COVID infection (RR 4.08;CI 95% 1.03 - 16.14) and IS due to OCEI. Classic stroke etiologies accounted for most of the cases of IS and concomitant COVID-19 infection but large-artery thrombosis was more common in infected than in non-infected patients.