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SARS-CoV-2 and Stroke Characteristics: A Report From the Multinational COVID-19 Stroke Study Group

Shima Shahjouei 1 Georgios Tsivgoulis 2, 3 Ghasem Farahmand 4 Eric Koza 5 Ashkan Mowla 1, 6 Alireza Vafaei Sadr 7 Arash Kia 8 Alaleh Vaghefi Far 4 Stefania Mondello 9 Achille Cernigliaro 10 Annemarei Ranta 11 Martin Punter 11 Faezeh Khodadadi 12 Soheil Naderi 4 Mirna Sabra 13 Mahtab Ramezani 14 Ali Amini Harandi 14 Oluwaseyi Olulana 5 Durgesh Chaudhary 1 Aicha Lyoubi 15 Bruce Campbell 16 Juan Arenillas 17 Daniel Bock 18 Joan Montaner 19 Saeideh Aghayari Sheikh Neshin 20 Diana Aguiar de Sousa 21 Matthew Tenser 6 Ana Aires 22, 23 Mercedes de Lera Alfonso 17 Orkhan Alizada 24 Elsa Azevedo 22, 23 Nitin Goyal 25 Zabihollah Babaeepour 26 Gelareh Banihashemi 4 Leo Bonati 27 Carlo Cereda 28 Jason Chang 29 Miljenko Crnjakovic 30 Gian Marco de Marchis 31 Massimo del Sette 32 Seyed Amir Ebrahimzadeh 33 Mehdi Farhoudi 34 Ilaria Gandoglia 32 Bruno Gonçalves 35 Christoph Griessenauer 1 Mehmet Murat Hanci 24 Aristeidis Katsanos 36 Christos Krogias 37 Ronen Leker 38 Lev Lotman 39 Jeffrey Mai 40 Shailesh Male 41 Konark Malhotra 42 Branko Malojcic 43, 44 Teresa Mesquita 45 Asadollah Mir Ghasemi 46 Hany Mohamed Aref 47 Zeinab Mohseni Afshar 48 Jusun Moon 49 Mika Niemelä 50, 51 Behnam Rezai Jahromi 50, 51 Lawrence Nolan 39 Abhi Pandhi 25 Jong-Ho Park 52 João Pedro Marto 45 Francisco Purroy 53 Sakineh Ranji-Burachaloo 4 Nuno Reis Carreira 53, 21 Manuel Requena 54, 55 Marta Rubiera 54, 55 Seyed Aidin Sajedi 56 João Sargento-Freitas 57 Vijay Sharma 58 Thorsten Steiner 18, 59 Kristi Tempro 39 Guillaume Turc 35 Yasaman Ahmadzadeh 60 Mostafa Almasi-Dooghaee 61 Farhad Assarzadegan 62 Arefeh Babazadeh 63 Humain Baharvahdat 64 Fabricio Buchadid Cardoso 65 Apoorva Dev 12 Mohammad Ghorbani 61 Ava Hamidi 66 Zeynab Sadat Hasheminejad 14 Sahar Hojjat-Anasri Komachali 67 Fariborz Khorvash 68 Firas Kobeissy 13, 69 Hamidreza Mirkarimi 70 Elahe Mohammadi-Vosough 70 Debdipto Misra 1 Ali Reza Noorian 71 Peyman Nowrouzi-Sohrabi 72 Sepideh Paybast 73 Leila Poorsaadat 74 Mehrdad Roozbeh 14 Behnam Sabayan 75 Saeideh Salehizadeh 76 Alia Saberi 20 Mercedeh Sepehrnia 14 Fahimeh Vahabizad 4 Thomas Alexandre Yasuda 65 Mojdeh Ghabaee 4 Nasrin Rahimian 33 Mohammad Hossein Harirchian 4 Afshin Borhani-Haghighi 72 Mahmoud Reza Azarpazhooh 77 Rohan Arora 78 Saeed Ansari 25 Venkatesh Avula 1 Jiang Li 1, 79 Vida Abedi 1, 79 Ramin Zand 1
Abstract : Background and Purpose: Stroke is reported as a consequence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in several reports. However, data are sparse regarding the details of these patients in a multinational and large scale. Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke, intracranial hemorrhage, and cerebral venous or sinus thrombosis among SARS-CoV-2–infected patients. We further investigated the risk of large vessel occlusion, stroke severity as measured by the National Institutes of Health Stroke Scale, and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with acute ischemic stroke. In addition, we explored the neuroimaging findings, features of patients who were asymptomatic for SARS-CoV-2 infection at stroke onset, and the impact of geographic regions and countries’ health expenditure on outcomes. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least 1 eligible stroke patient. Of 432 patients included, 323 (74.8%) had acute ischemic stroke, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis. A total of 183 (42.4%) patients were women, 104 (24.1%) patients were <55 years of age, and 105 (24.4%) patients had no identifiable vascular risk factors. Among acute ischemic stroke patients, 44.5% (126 of 283 patients) had large vessel occlusion; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median National Institutes of Health Stroke Scale (8 [3–17] versus 11 [5–17]; P =0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; P <0.001) in countries with middle-to-high health expenditure when compared with countries with lower health expenditure. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144 (37.8%) were asymptomatic at the time of admission for SARS-CoV-2 infection. Conclusions: We observed a considerably higher rate of large vessel occlusions, a much lower rate of small vessel occlusion and lacunar infarction, and a considerable number of young stroke when compared with the population studies before the pandemic. The rate of mechanical thrombectomy was significantly lower in countries with lower health expenditures.
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https://www.hal.inserm.fr/inserm-03281475
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Submitted on : Thursday, July 8, 2021 - 11:31:38 AM
Last modification on : Tuesday, November 16, 2021 - 5:25:51 AM
Long-term archiving on: : Saturday, October 9, 2021 - 6:30:09 PM

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Shima Shahjouei, Georgios Tsivgoulis, Ghasem Farahmand, Eric Koza, Ashkan Mowla, et al.. SARS-CoV-2 and Stroke Characteristics: A Report From the Multinational COVID-19 Stroke Study Group. Stroke, American Heart Association, 2021, 52 (5), pp.e117-e130. ⟨10.1161/STROKEAHA.120.032927⟩. ⟨inserm-03281475⟩

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