SARS-CoV-2 and Stroke Characteristics-Reference-Cited by-同舟云学术

SARS-CoV-2 and Stroke Characteristics

Published:2021-05 Issue:5 Volume:52 Page:
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Shahjouei Shima¹^ORCID,Tsivgoulis Georgios²,Farahmand Ghasem³⁴^ORCID,Koza Eric⁵,Mowla Ashkan¹⁶,Vafaei Sadr Alireza⁷^ORCID,Kia Arash⁸^ORCID,Vaghefi Far Alaleh⁴,Mondello Stefania⁹,Cernigliaro Achille¹⁰,Ranta Annemarei¹¹,Punter Martin¹¹^ORCID,Khodadadi Faezeh¹²^ORCID,Naderi Soheil¹³,Sabra Mirna¹⁴^ORCID,Ramezani Mahtab¹⁵^ORCID,Amini Harandi Ali¹⁵^ORCID,Olulana Oluwaseyi⁵,Chaudhary Durgesh¹,Lyoubi Aicha¹⁶^ORCID,Campbell Bruce C.V.¹⁷,Arenillas Juan F.¹⁸,Bock Daniel¹⁹^ORCID,Montaner Joan²⁰,Aghayari Sheikh Neshin Saeideh²¹^ORCID,Aguiar de Sousa Diana²²²³,Tenser Matthew S.⁶,Aires Ana²⁴²⁵,Alfonso Mercedes de Lera¹⁸,Alizada Orkhan²⁶,Azevedo Elsa²⁴²⁵,Goyal Nitin²⁷,Babaeepour Zabihollah²⁸,Banihashemi Gelareh²⁹,Bonati Leo H.³⁰,Cereda Carlo W.³¹^ORCID,Chang Jason J.³²,Crnjakovic Miljenko³³^ORCID,De Marchis Gian Marco³⁴^ORCID,Del Sette Massimo³⁵,Ebrahimzadeh Seyed Amir³⁶^ORCID,Farhoudi Mehdi³⁷,Gandoglia Ilaria³⁵^ORCID,Gonçalves Bruno³⁸,Griessenauer Christoph J.¹,Murat Hanci Mehmet²⁶^ORCID,Katsanos Aristeidis H.²³⁹,Krogias Christos⁴⁰,Leker Ronen R.⁴¹,Lotman Lev⁴²,Mai Jeffrey⁴³,Male Shailesh⁴⁴,Malhotra Konark⁴⁵^ORCID,Malojcic Branko⁴⁶,Mesquita Teresa⁴⁷,Mir Ghasemi Asadollah⁴⁸^ORCID,Mohamed Aref Hany⁴⁹^ORCID,Mohseni Afshar Zeinab⁵⁰,Moon Jusun⁵¹^ORCID,Niemelä Mika⁵²,Rezai Jahromi Behnam⁵²^ORCID,Nolan Lawrence⁴²,Pandhi Abhi²⁷^ORCID,Park Jong-Ho⁵³^ORCID,Marto João Pedro⁴⁷,Purroy Francisco⁵⁴^ORCID,Ranji-Burachaloo Sakineh³,Carreira Nuno Reis⁵⁵⁵⁴^ORCID,Requena Manuel⁵⁶⁵⁷,Rubiera Marta⁵⁶⁵⁷,Sajedi Seyed Aidin⁵⁸,Sargento-Freitas João⁵⁹^ORCID,Sharma Vijay K.⁶⁰^ORCID,Steiner Thorsten⁶¹⁶²,Tempro Kristi⁴²,Turc Guillaume³⁸,Ahmadzadeh Yasaman⁶³^ORCID,Almasi-Dooghaee Mostafa⁶⁴⁶⁵⁶⁶⁶⁷^ORCID,Assarzadegan Farhad,Babazadeh Arefeh⁶⁸,Baharvahdat Humain⁶⁹^ORCID,Cardoso Fabricio Buchadid⁷⁰^ORCID,Dev Apoorva¹²,Ghorbani Mohammad⁶⁴^ORCID,Hamidi Ava⁷¹,Hasheminejad Zeynab Sadat⁷²,Hojjat-Anasri Komachali Sahar⁷³,Khorvash Fariborz⁷⁴,Kobeissy Firas¹⁴⁷⁵^ORCID,Mirkarimi Hamidreza⁷⁶,Mohammadi-Vosough Elahe⁷⁶,Misra Debdipto⁷⁷,Noorian Ali Reza⁷⁸,Nowrouzi-Sohrabi Peyman⁷⁹^ORCID,Paybast Sepideh⁸⁰^ORCID,Poorsaadat Leila⁸¹,Roozbeh Mehrdad⁸²,Sabayan Behnam⁸³^ORCID,Salehizadeh Saeideh⁸⁴,Saberi Alia²¹,Sepehrnia Mercedeh⁷²,Vahabizad Fahimeh²⁹^ORCID,Yasuda Thomas Alexandre⁷⁰,Ghabaee Mojdeh³⁴^ORCID,Rahimian Nasrin⁸⁵^ORCID,Harirchian Mohammad Hossein³^ORCID,Borhani-Haghighi Afshin⁸⁶,Azarpazhooh Mahmoud Reza⁸⁷,Arora Rohan⁸⁸,Ansari Saeed²⁷,Avula Venkatesh⁸⁹^ORCID,Li Jiang⁸⁹⁹⁰,Abedi Vida⁸⁹⁹⁰,Zand Ramin¹^ORCID

Affiliation:

1. Neurology Department, Neuroscience Institute, Geisinger Health System, PA (S. Shahjouei, A. Mowla, D.C., C.J.G., R.Z.).

2. Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, Greece (G. Tsivgoulis, A.H.K.).

3. Iranian Center of Neurological Research, Neuroscience Institute (G.F., S.R.-B., M. Ghabaee, M.H.H.), Tehran University of Medical Sciences, Iran.

4. Neurology Department (G.F., A.V.F., M. Ghabaee), Tehran University of Medical Sciences, Iran.

5. Geisinger Commonwealth School of Medicine, Scranton, PA (E.K., O.O.).

6. Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA (A. Mowla, M.S.T.).

7. Department de Physique Theorique and Center for Astroparticle Physics, University Geneva, Switzerland (A.V.S.).

8. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York City, NY (A.K.).

9. Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy (S. Mondello).

10. Regional Health Authority of Sicily, Palermo, Italy (A.C.).

11. Department of Neurology, Wellington Hospital, New Zealand and Department of Medicine, University of Otago, New Zealand (A.R., M.P.).

12. PES University, Bangaluru, Karnataka, India (F. Khodadadi, A.D.).

13. Department of Neurosurgery (S.N.), Tehran University of Medical Sciences, Iran.

14. Neurosciences Research Center, Lebanese University/Medical School, Beirut, Lebanon (M. Sabra, F. Kobeissy).

15. Neurology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Ramezani, A.A.H.).

16. Neurology Department, Delafontaine Hospital, Saint-Denis, France (A.L.).

17. Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C.).

18. Department of Neurology, University of Valladolid, Spain (J.F.A., M.D.L.A.).

19. Department of Cardiology, Klinikum Frankfurt Höchst, Germany (D.B.).

20. Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain (J. Montaner).

21. Neurology Department, Poursina Hospital, Rasht, Guilan, Iran (S.A.S.N., A.S.).

22. Department of Neurology (D.A.d.S.), Hospital de Santa Maria, University of Lisbon, Portugal.

23. Department of Neurology, Hospital de Santa Maria, University of Lisbon, Portugal (D.A.d.S.).

24. Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal (A.A., E.A.).

25. Department of Medicine, University of Porto, Portugal (A.A., E.A.).

26. Neurosurgery Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Turkey (O.A., M.M.H.).

27. Department of Neurology, University of Tennessee (N.G., A.P., S.A.).

28. Neurology Ward, Valiasr Hospital, Borujen, Iran (Z.B.).

29. Imam Khomeini Hospital, and Neurology Department, Sina Hospital (G.B., F.V.), Tehran University of Medical Sciences, Iran.

30. Department of Neurology and Stroke Unit, University Hospital Basel, Switzerland (L.H.B.).

31. Stroke Center, Neurocenter of Southern Switzerland, Lugano (C.W.C.).

32. Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC (J.J.C.).

33. Intensive Care Unit, Department of Neurology, Clinical Hospital Dubrava, Zagreb, Croatia (M.C.).

34. Neurorehabilitation Unit, University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, University of Basel, Switzerland (G.D.M.).

35. Neurology Unit, Galliera Hospital, Genova, Italy (M.D.S., I.G.).

36. Department of Radiology, Yasrebi Hospital, Kashan, Iran (S.A.E.).

37. Neurosciences Research Center, Tabriz University of Medical Sciences, Iran (M.F.).

38. Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, France (B.G., G. Turc).

39. Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada (A.H.K.).

40. Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Germany (C.K.).

41. Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.).

42. Department of Neurology, Albany Medical Center, NY (L.L., L.N., K.T.).

43. Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, DC (J. Mai).

44. Department of Neurosurgery, Vidant Medical Center, Greenville, NC (S. Male).

45. Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M.).

46. Department of Neurology, TIA Clinic, University Hospital Centre Zagreb, Zagreb School of Medicine, University of Zagreb, Croatia (B.M.).

47. Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (T.M., J.P.M.).

48. Department of Anesthesiology, University of Ottawa, Canada (A.M.G.).

49. Department of Neurology, Ain Shams University, Cairo, Egypt (H.M.A.).

50. Infection Disease Research Center, Kermanshah University of Medical Sciences, Iran (Z.M.A.).

51. Department of Neurology, National Medical Center, Seoul, South Korea (J. Moon).

52. Department of Neurosurgery, Helsinki University and Helsinki University Hospital, Finland (M.N., B.R.J.).

53. Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, South Korea (J.-H.P.).

54. Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, Spain (F.P., N.R.C.)

55. Department of Internal Medicine (N.E.C.), Hospital de Santa Maria, University of Lisbon, Portugal.

56. Stroke Unit, Department of Neurology, Hospital Vall d’Hebron Barcelona, Spain (M. Requena, M. Rubiera).

57. Department de Medicina, Universitat Autònoma de Barcelona, Spain (M. Requena, M. Rubiera).

58. Department of Neurology, Neuroscience Research Center, Golestan University of Medical Sciences, Iran (S.A.S.).

59. Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal (J.S.-F.).

60. Division of Neurology, University Medicine Cluster, National University Health System, Singapore (V.K.S.).

61. Department of Neurology, Klinikum Frankfurt Höchst, Germany (T.S.).

62. Department of Neurology, Heidelberg University Hospital, Germany (T.S.).

63. Hospital for Special Surgery, New York City, NY (Y.A.).

64. Divisions of Vascular and Endovascular Neurosurgery (M.A.-D., M. Ghorbani), Firoozgar Hospital, Iran University of Medical Sciences, Tehran.

65. Neurology (M.A.-D.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran.

66. Divisions of Vascular and Endovascular Neurosurgery (M.A.-D.), Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran.

67. Neurology (M.A.-D.), Rasoul-Akram Hospital, Iran University of Medical Sciences, Tehran.

68. Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Iran (A.B.).

69. Neurosurgical Department, Ghaem Hospital, Mashhad University of Medical Sciences, Iran (H.B.).

70. Neurology Department, Centro Médico de Campinas, São Paulo, Brazil (F.B.C., T.A.Y.).

71. Neurology Ward, Gheshm Hospital, Iran (A.H.).

72. Department of Neurology, Imam Hosein Hospital, Shahid Beheshti Medical University, Tehran, Iran (Z.S.H., M. Sepehrnia).

73. Department of Neurology, Pirooz Hospital, Gilan University of Medical Sciences, Lahijan, Iran (S.H.-A.K.).

74. Neurology Department, Isfahan University of Medical Sciences, Iran (F. Khorvash).

75. Program of Neurotrauma, Neuroproteomics and Biomarker Research, University of Florida (F. Kobeissy).

76. Neurology Department, Modarres Hospital, Kashmar, Iran (H.M., E.M.-V.).

77. Steele Institute of Health and Innovation, Geisinger Health System, PA (D.M.).

78. Department of Neurology, Southern California Permanente Medical Group, Irvine, CA (A.R.N.).

79. Student Research Committee (P.N.-S.), Shiraz University of Medical Sciences, Iran.

80. Department of Neurology, Bou Ali Hospital, Qazvin University of Medical Sciences, Iran (S.P.).

81. Department of Neurology, Arak University of Medical Sciences, Iran (L.P.).

82. Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M. Roozbeh).

83. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (B.S.).

84. Neurology Department, Salahadin Ayubi Hospital, Baneh, Iran (S. Salehizadeh).

85. Department of Neurology, Yasrebi Hospital, Kashan, Iran (N.R.).

86. Clinical Neurology Research Center (A.B.-H.), Shiraz University of Medical Sciences, Iran.

87. Neurology Department, Western University, Canada (M.R.A.).

88. Department of Neurology, Long Island Jewish Forest Hills, Queens, NY (R.A.).

89. Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA (V. Avula, V. Abedi, J.L.).

90. Biocomplexity Institute, Virginia Tech, Blacksburg, VA (J.L., V. Abedi).

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

Link

https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.032927

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