Isabella Canavero, MD

International Stroke Conference 2021
March 17–19, 2021
Presentation LB15

Srivastava PK, Zhang S, Xian Y, Xu H, Rutan C, Alger HM, Walchok J, Williams J, de Lemos JA, Decker-Palmer MR, et al. Acute Ischemic Stroke in Patients With COVID-19: An Analysis From Get With The Guidelines–Stroke. Stroke. 2021.

Actually, both COVID-19 and stroke represent pandemic diseases: To date, they account for the most frequent illnesses worldwide. In addition, upcoming evidence from medical literature suggests that the ultimate overlap of COVID-19 with the everlasting stroke “pandemic” has led to increasing rates of adverse outcomes.

In this paper, Srivastava et al. investigated clinical features and outcomes of patients with acute ischemic stroke and COVID-19 in the United States in the first 4-months period of the COVID-19 outbreak, by using data from the Get With The Guidelines-Stroke network. Nearly 42,000 acute ischemic stroke patients, hospitalized in 458 GWTG-Stroke hospitals, were identified: Of them, about 1,150 were also affected by COVID-19. Comparing acute ischemic stroke patients with or without COVID-19, younger age, Black, Hispanic and Asian ethnicity, higher NIHSS scores, and large vessel occlusions were found to be significantly more represented in the COVID-19 subgroup, supporting the negative impact of the infection on stroke outcome. Furthermore, acute ischemic stroke patients with COVID-19 were featured by longer times to evaluation and treatment, and worse morbidity and mortality compared to COVID-19-free patients.

The greater clinical severity and worse outcomes of patients affected by both diseases could find explanation in the well-known multi-systemic involvement of SARS-CoV-2 infection, including effects on blood coagulation cascade and thrombosis, although this study lacked specific data about COVID-19 severity and course. The differences found in patients of some ethnicities outlined the existence of systemic social inequities. The observed longer process timings are reasonably determined by time-consuming COVID-19 triage procedures, which could also negatively contribute to clinical outcome. However, some potential selection biases could have affected the results: For example, a number of patients could have avoided hospitalization — and skipped the statistics — due to lower neurological and global clinical severity, or older age, according to the highly recommended “stay-at-home-if-you-can” policy.

It has to be outlined that many outstanding issues of the COVID-19 pandemic come from intrinsic obstacles in performing reliable measurements and selecting adequate controls due to the pitfalls of a worldwide emergency scenario, where practical hygienic protocols, fear of contagion, and social inequities are only the most evident confounders.