Incidence, Characteristics and Outcomes of Large Vessel Stroke in COVID-19 Cohort: A Multicentric International Study.

Importance: Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is a global pandemic that has been an immense burden on the healthcare systems all over the world. While there are case reports of acute ischemic stroke (AIS) the overall incidence of acute ischemic stroke in COVID -19 patients is yet to be determined. Also, whether the hypercoagulability seen in COVID-19 patients leads to larger thromboemboli and hence increase large vessel occlusion stroke (LVOs) is unclear. Design, Setting, and Participants: This is a retrospective, international multicenter case series of LVOs. Data was collected from March 1, 2020, to May 1, 2020, at 12 stroke centers located in COVID-19 hotspots from 4 different countries. Detailed data was collected on consecutive LVOs hospitalized patients with laboratory-confirmed diagnosis of severe acute respiratory syndrome coronavirus 2 infection.Main Outcomes and Measures: We measured the incidence of AIS and LVOs in the hospitalized COVID-19 patients. Among patients who underwent Mechanical thrombectomy, we measured the stroke outcomes ( site of occlusion, tandem occlusion, revascularization rates, time to present to the hospital), along with COVID-19 symptoms, and overall outcomes in these patients. Results Of 6698 patients admitted with COVID-19 patients in 10 centers, the incidence of stroke was noted in 1.3 % (range .6-2.6 %). The median age of patients who presented with LVOs was 51 years mean (range 27-87years and in the US centers, African Americans comprised 28% of the race-ethnic distribution. 10 patients (16 %) were less than 50 y of age with no significant risk factors for LVOs in the majority of them. Among the LVOs eligible for MT, the average time to presentation from symptom onset to emergency room was 9.3 hours. Successful revascularization was achieved in 81% of patients and the intracranial hemorrhage rate was 14% with no symptomatic hemorrhages. 21 (50%) patients were either discharged to home or to acute rehabilitation facilities. Conclusions and Relevance: LVOs was predominant in patients with AIS and COVID-19, occurring at a significantly younger age and affecting African Americans disproportionately.