Early Brain Imaging Shows Increased Severity of Acute Ischemic Strokes With Large Vessel Occlusion in COVID-19 Patients
Early Brain Imaging Shows Increased Severity of Acute Ischemic Strokes With Large Vessel Occlusion in COVID-19 Patients
复制标题
DOI：
10.1161/strokeaha.120.031011
复制
发表时间：
2020-11-01
期刊：
影响因子：
8.3
通讯作者：
Piotin, Michel
中科院分区：
文献类型：
--
作者：
Escalard, Simon;Chalumeau, Vanessa;Piotin, Michel
背景和目的：关于急性缺血性卒中与大血管闭塞和2019冠状病毒病（COVID-19）相关性的报告不断出现。虽然这些患者的严重程度可能会因呼吸和神经损伤而增加，但COVID-19中风患者可能会出现轻度或无呼吸道症状。我们的目的是比较有和没有COVID-19的患者之间的前循环大血管闭塞卒中严重程度。方法：我们在我们机构的COVID-19爆发的前6周内对患有前循环大血管闭塞并在发病后3小时内进行早期脑成像的COVID-19患者进行了一项比较队列研究，并在2019年同期住院的对照组中进行了比较。结果：十二冠-在研究期间纳入了19例前循环大血管闭塞和早期脑成像的患者，并与34例前循环大血管的对照患者进行了比较闭塞和早期脑成像。COVID-19组的患者更年轻（P=0.032），糖尿病史更频繁（P=0.039）。患者在最初的国立卫生研究院卒中量表和从发病到成像的时间上没有显著差异（分别为P=0.18和P=0.6）。与非COVID-19患者相比，COVID-19患者的中风更严重，血栓负荷评分显著降低（中位数：6.5 vs 8，P=0.016），多支血管闭塞率较高（50% vs 8.8%，P=0.005），DWI方面较低（弥散加权成像-阿尔伯塔卒中项目早期CT评分;中位数：5比8，P=0.006），以及较高的梗死核心体积（中位数：58比6 mL，P=0.004）。两组的成功再通率相似（P=0.767）。COVID-19患者组的住院死亡率更高（41.7%对11.8%，P=0.025）。结论：早期脑成像显示COVID-19患者中大血管闭塞性卒中的严重程度更高。鉴于感染患者人数众多，应该对全球大流行即将对神经血管造成的影响表示担忧。
Background and Purpose:Reports are emerging regarding the association of acute ischemic strokes with large vessel occlusion and coronavirus disease 2019 (COVID-19). While a higher severity of these patients could be expected from the addition of both respiratory and neurological injury, COVID-19 patients with strokes can present with mild or none respiratory symptoms. We aimed to compare anterior circulation large vessel occlusion strokes severity between patients with and without COVID-19.Methods:We performed a comparative cohort study between patients with COVID-19 who had anterior circulation large vessel occlusion and early brain imaging within 3 hours from onset, in our institution during the 6 first weeks of the COVID-19 outbreak and a control group admitted during the same calendar period in 2019.Results:Twelve COVID-19 patients with anterior circulation large vessel occlusion and early brain imaging were included during the study period and compared with 34 control patients with anterior circulation large vessel occlusion and early brain imaging in 2019. Patients in the COVID-19 group were younger (P=0.032) and had a history of diabetes mellitus more frequently (P=0.039). Patients did not significantly differ on initial National Institutes of Health Stroke Scale nor time from onset to imaging (P=0.18 and P=0.6, respectively). Patients with COVID-19 had more severe strokes than patients without COVID-19, with a significantly lower clot burden score (median: 6.5 versus 8, P=0.016), higher rate of multivessel occlusion (50% versus 8.8%, P=0.005), lower DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early CT Scores; median: 5 versus 8, P=0.006), and higher infarct core volume (median: 58 versus 6 mL, P=0.004). Successful recanalization rate was similar in both groups (P=0.767). In-hospital mortality was higher in the COVID-19 patients' group (41.7% versus 11.8%, P=0.025).Conclusions:Early brain imaging showed higher severity large vessel occlusion strokes in patients with COVID-19. Given the massive number of infected patients, concerns should be raised about the coming neurovascular impact of the pandemic worldwide.