Siegler James E, Abdalkader Mohamad, Michel Patrik, Nguyen Thanh N
Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA.
Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
J Stroke. 2022 May;24(2):179-188. doi: 10.5853/jos.2022.00843. Epub 2022 May 31.
As of May 2022, there have been more than 400 million cases (including re-infections) of the systemic acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), and nearly 5 million deaths worldwide. Not only has the coronavirus disease 2019 (COVID-19) pandemic been responsible for diagnosis and treatment delays of a wide variety of conditions, and overwhelmed the allocation of healthcare resources, it has impacted the epidemiology and management of cerebrovascular disease. In this narrative review, we summarize the changing paradigms and latest data regarding the complex relationship between COVID-19 and cerebrovascular disease. Paradoxically, although SARS-CoV-2 has been associated with many thrombotic complications-including ischemic stroke-there have been global declines in ischemic stroke and other cerebrovascular diseases. These epidemiologic shifts may be attributed to patient avoidance of healthcare institutions due to fear of contracting the novel human coronavirus, and also related to declines in other transmissible infectious illnesses which may trigger ischemic stroke. Despite the association between SARS-CoV-2 and thrombotic events, there are inconsistent data regarding targeted antithrombotics to prevent venous and arterial events. In addition, we provide recommendations for the conduct of stroke research and clinical trial planning during the ongoing COVID-19 pandemic, and for future healthcare crises.
截至2022年5月，全球范围内，系统性急性呼吸综合征冠状病毒2（SARS-CoV-2）感染病例（包括再次感染）已超过4亿例，死亡近500万例。2019冠状病毒病（COVID-19）大流行不仅导致多种疾病的诊断和治疗延迟，使医疗资源分配不堪重负，还对脑血管疾病的流行病学和管理产生了影响。在这篇叙述性综述中，我们总结了关于COVID-19与脑血管疾病之间复杂关系的不断变化的模式和最新数据。矛盾的是，尽管SARS-CoV-2与许多血栓形成并发症有关，包括缺血性中风，但全球范围内缺血性中风和其他脑血管疾病的发病率却有所下降。这些流行病学转变可能归因于患者因担心感染新型人类冠状病毒而避免前往医疗机构，也与其他可能引发缺血性中风的传染性疾病发病率下降有关。尽管SARS-CoV-2与血栓形成事件之间存在关联，但关于预防静脉和动脉事件的靶向抗栓药物的数据并不一致。此外，我们针对在当前COVID-19大流行期间以及未来医疗危机中开展中风研究和临床试验规划提供了建议。
