Descriptive Analysis of Acute Ischemic Stroke in COVID-19 Patients Through The Course of COVID-19 Pandemic

ABSTRACT

Objective: To describe our initial institutional experience in the treatment of patients with COVID-19 presenting with acute ischemic stroke (AIS) during the initial and subsequent COVID-19 infection surges, including reporting long-term outcomes. Background: Acute stroke care has been negatively impacted and/or delayed during the initial outbreak of COVID-19 with subsequent improvement over time. We highlight challenges encountered in identification and investigative workup of these patients, treatment concerns, evolution of AIS characteristics and management from 2020 to 2021, effects of COVID-19 vaccination, and considerations for future investigations. Design/Methods: All consecutive patients with COVID-19 and AIS treated at our institution during the COVID-19 outbreak, between March 1, 2020 and August 31, 2021 were included. Due to consideration for differences in patient management early and later in the COVID-19, patients were categorized in two separate cohorts 1) patients diagnosed with AIS during the initial peak of COVID-19 (March thru October 2020), and 2) subsequent surges in infection (November 2020 thru August 2021). Baseline demographics, clinical, imaging, and outcomes data were retrospectively determined. Results: Of 2512 COVID-19 patients, 35 (1.39%, mean age 63.3 years, 54% women) had AIS. AIS recognition was frequently delayed after COVID-19 symptoms (median 19.5 days). AIS mechanism was undetermined or due to multiple etiologies in most cases (n=20, 57%). Three patients from the second cohort each received one dose of an mRNA COVID-19 vaccine. Comparative analysis showed that patients in the later cohort had earlier AIS presentation, fewer stroke risk factors, more comprehensive workup, more defined stroke mechanisms, lower incidence of critical COVID-19 severity, and greater utilization of IV TPA. Despite these differences, AIS incidence, NIHSS, and overall outcomes were similar, with most patients experiencing worsening or static functional 3-month outcomes. Conclusions: Further studies should investigate outcomes beyond 3 months and their predictive factors, impact of completed vaccination course, and access to neurologic care.