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Título

Stroke etiologies in patients with COVID-19

Resumo

Patients with severe COVID-19 may have an increased risk of venous and arterial thrombotic events, including ischemic stroke (IS). It has been hypothesized that the infection by SARS-CoV-2 alone may be a risk factor for IS, particularly in young subjects. We designed an observational retrospective cohort to compare stroke etiologies in patients with IS, with (ISCOVID+) or without (ISCOVID-) SARS-CoV-2 infection, defined by molecular detection of SARS-CoV-2 before the stroke, or within 15 days after stroke or detection of serum antibodies before or within 30 days after the IS. The primary outcome was the stroke etiology according to the Causative Classification System for Ischemic Stroke (CCS) algorithm. In addition, two subgroups were determined for the category of Other uncommon Causes (OC): iatrogenic causes (OC-IC) and Other uncommon Causes excluding iatrogenic (OC-EI). A total of 212 patients were included (160 in ISCOVID+ and 42 in ISCOVID-). Cardio-aortic embolism (CE) was the most common etiology in the two groups. Two patients in the ISCOVID+ group but none in the ISCOVID-group had unexplained thrombosis of the common carotid artery. There were independent associations between younger age (RR 0.91, 95% CI 0.87 – 0.95) as well as COVID-19 infection (RR 4.08; CI 95% 1.03 – 16.14) and IS due to OC-EI. Classic stroke etiologies accounted for most of the cases of IS and concomitant COVID-19 infection, but large-artery thrombosis was more common in infected than in non-infected patients.

Palavras Chave

Stroke Etiologies COVID-19 SARS-CoV-2 Epidemiology Ischemic