John Seby, Hussain Syed Irteza, Piechowski-Jozwiak Bartlomiej, Dibu Jamil, Kesav Praveen, Bayrlee Ahmad, Elkambergy Hussam, John Terrence Lee St, Roser Florian, Mifsud Victoria Ann
Department of Neurology, Neurological Institute, Cleveland Clinic Abu Dhabi; Neurointerventional Surgery, Neurological Institute, Cleveland Clinic Abu Dhabi.
Department of Neurology, Neurological Institute, Cleveland Clinic Abu Dhabi; Neurointerventional Surgery, Neurological Institute, Cleveland Clinic Abu Dhabi.
Clin Neurol Neurosurg. 2020 Dec;199:106227. doi: 10.1016/j.clineuro.2020.106227. Epub 2020 Sep 11.
To compare ischemic and hemorrhagic stroke patients with COVID-19 to non-COVID-19 controls, and to describe changes in stroke admission patterns during the pandemic.
This is a single center, retrospective, observational study. All consecutive patients admitted with primary diagnosis of ischemic/ hemorrhagic stroke between March1st -May10th 2020 were included and compared with the same time period in 2019.
There was a 41.9% increase in stroke admissions in 2020 (148 vs 210,P = .001). When comparing all ischemic strokes, higher rate of large vessel occlusion (LVO) (18.3% vs 33.8%,P = .008) and significant delay in initiation of mechanical thrombectomy after hospital arrival (67.75 vs 104.30 minutes,P = .001) was observed in 2020. When comparing all hemorrhagic strokes, there were no differences between the two years. Among 591 COVID-19 admissions, 31 (5.24%) patients with stroke including 19 with ischemic (3.21%) and 12 with hemorrhagic stroke (2.03%) were identified. Patients with COVID-19 and ischemic stroke were significantly younger (58.74 vs 48.11 years,P = .002), predominantly male (68.18% vs 94.74%,P = .016), had lesser vascular risk factors, had more severe clinical presentation (NIHSS 7.01 vs 17.05,P < .001), and higher rate of LVO (23.6% vs. 63.1%,P = .006). There was no difference in the rate of endovascular thrombectomy, but time to groin puncture was significantly longer in COVID-19 patients (83.41 vs 129.50 minutes,P = .003). For hemorrhagic stroke, COVID-19 patients did not differ from non-COVID-19 patients.
Stroke continues to occur during this pandemic and stroke pathways have been affected by the pandemic. Stroke occurs in approximately 5% of patients with COVID-19. COVID-19 associated ischemic stroke occurs in predominantly male patients who are younger, with fewer vascular risk factors, can be more severe, and have higher rates of LVO. Despite an increase in LVO during the pandemic, treatment with mechanical thrombectomy has not increased. COVID-19 associated hemorrhagic stroke does not differ from non-COVID-19 hemorrhagic stroke patients.
比较患有新型冠状病毒肺炎（COVID-19）的缺血性和出血性卒中患者与非COVID-19对照者，并描述疫情期间卒中入院模式的变化。
这是一项单中心、回顾性观察研究。纳入2020年3月1日至5月10日期间所有以缺血性/出血性卒中为主要诊断入院的连续患者，并与2019年同期进行比较。
2020年卒中入院人数增加了41.9%（148例对210例，P = 0.001）。在比较所有缺血性卒中时，2020年观察到较大血管闭塞（LVO）发生率更高（18.3%对33.8%，P = 0.008），且入院后开始机械取栓的时间显著延迟（67.75分钟对104.30分钟，P = 0.001）。在比较所有出血性卒中时，两年间无差异。在591例COVID-19入院患者中，识别出31例（5.24%）卒中患者，其中19例为缺血性卒中（3.21%），12例为出血性卒中（2.03%）。患有COVID-19和缺血性卒中的患者明显更年轻（58.74岁对48.11岁，P = 0.002），男性居多（68.18%对94.74%，P = 0.016），血管危险因素较少，临床表现更严重（美国国立卫生研究院卒中量表评分7.01对17.05，P < 0.001），且LVO发生率更高（23.6%对63.1%，P = 0.006）。血管内取栓率无差异，但COVID-19患者腹股沟穿刺时间明显更长（83.41分钟对129.50分钟，P = 0.003）。对于出血性卒中，COVID-19患者与非COVID-19患者无差异。
在此次疫情期间卒中仍会发生，且卒中诊疗流程受到疫情影响。约5%的COVID-19患者会发生卒中。与COVID-19相关的缺血性卒中主要发生在更年轻、血管危险因素较少的男性患者中，病情可能更严重，且LVO发生率更高。尽管疫情期间LVO有所增加，但机械取栓治疗并未增多。与COVID-19相关的出血性卒中与非COVID-19出血性卒中患者无差异。
