Etiologic Subtypes of Ischemic Stroke in SARS-CoV-2 Patients in a Cohort of New York City Hospitals
Objective: To describe the ischemic stroke subtypes related to coronavirus disease 2019 (COVID-19) in a cohort of New York City hospitals and explore their etiopathogenesis.Background: Most neurological manifestations are non-focal, but few have reported the characteristics of ischemic strokes or in...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-09-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2020.01004/full |
| _version_ | 1828421822354292736 |
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| author | Ambooj Tiwari Ambooj Tiwari Ambooj Tiwari Ambooj Tiwari Ketevan Berekashvili Ketevan Berekashvili Ketevan Berekashvili Ketevan Berekashvili Volodomyr Vulkanov Shashank Agarwal Amit Khaneja David Turkel-Parella David Turkel-Parella David Turkel-Parella David Turkel-Parella Jeremy Liff Jeremy Liff Jeremy Liff Jeremy Liff Jeffrey Farkas Jeffrey Farkas Jeffrey Farkas Jeffrey Farkas Thambirajah Nandakumar Ting Zhou Jennnifer Frontera David E. Kahn Sun Kim Kelly A. Humbert Matthew D. Sanger Shadi Yaghi Aaron Lord Karthikeyan Arcot Karthikeyan Arcot Karthikeyan Arcot Karthikeyan Arcot Adam A. Dmytriw |
| author_facet | Ambooj Tiwari Ambooj Tiwari Ambooj Tiwari Ambooj Tiwari Ketevan Berekashvili Ketevan Berekashvili Ketevan Berekashvili Ketevan Berekashvili Volodomyr Vulkanov Shashank Agarwal Amit Khaneja David Turkel-Parella David Turkel-Parella David Turkel-Parella David Turkel-Parella Jeremy Liff Jeremy Liff Jeremy Liff Jeremy Liff Jeffrey Farkas Jeffrey Farkas Jeffrey Farkas Jeffrey Farkas Thambirajah Nandakumar Ting Zhou Jennnifer Frontera David E. Kahn Sun Kim Kelly A. Humbert Matthew D. Sanger Shadi Yaghi Aaron Lord Karthikeyan Arcot Karthikeyan Arcot Karthikeyan Arcot Karthikeyan Arcot Adam A. Dmytriw |
| author_sort | Ambooj Tiwari |
| collection | DOAJ |
| description | Objective: To describe the ischemic stroke subtypes related to coronavirus disease 2019 (COVID-19) in a cohort of New York City hospitals and explore their etiopathogenesis.Background: Most neurological manifestations are non-focal, but few have reported the characteristics of ischemic strokes or investigated its pathophysiology.Methods: Data were collected prospectively April 1-April 15, 2020 from two centers in New York City to review possible ischemic stroke types seen in COVID-19-positive patients. Patient presentation, demographics, related vascular risk factors, associated laboratory markers, as well as imaging and outcomes were collected.Results: The age of patients ranged between 27 and 82 years. Approximately 81% of patients had known vascular risk factors, the commonest being hypertension (75%) followed by diabetes (50%) coronary disease or atrial fibrillation. Eight patients presented with large vessel occlusion (LVO) with median age 55 years (27-82) and all were male. Eight patients presented with non-LVO syndromes, with median age 65.5 years (59–82) and most were female (62.5%). Both groups were 50% African Americans and 37.5% South Asian. Both groups had similar D-dimer levels although other acute phase reactants/disease severity markers (Ferritin, CRP, procalcitonin) were higher in the LVO group. The LVO group also had a significantly higher mortality compared to the non-LVO group. The most common etiology was cryptogenic (6 patients) followed by small vessel occlusion (3 patients) and undetermined-unclassified (3 patients). For the remaining 4 patients, 2 were identified as cardioembolic and 2 with large artery atherosclerosis.Conclusion: COVID-19-related ischemic events can present as small vessel occlusions, branch emboli or large vessel occlusions. The most common etiology is cryptogenic. Patients with LVO syndromes tend to be younger, male and may have elevated acute inflammatory markers. |
| first_indexed | 2024-12-10T15:38:29Z |
| format | Article |
| id | doaj.art-feae21f7f5dc4b1da838f49d81749a56 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-10T15:38:29Z |
| publishDate | 2020-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-feae21f7f5dc4b1da838f49d81749a562022-12-22T01:43:11ZengFrontiers Media S.A.Frontiers in Neurology1664-22952020-09-011110.3389/fneur.2020.01004556434Etiologic Subtypes of Ischemic Stroke in SARS-CoV-2 Patients in a Cohort of New York City HospitalsAmbooj Tiwari0Ambooj Tiwari1Ambooj Tiwari2Ambooj Tiwari3Ketevan Berekashvili4Ketevan Berekashvili5Ketevan Berekashvili6Ketevan Berekashvili7Volodomyr Vulkanov8Shashank Agarwal9Amit Khaneja10David Turkel-Parella11David Turkel-Parella12David Turkel-Parella13David Turkel-Parella14Jeremy Liff15Jeremy Liff16Jeremy Liff17Jeremy Liff18Jeffrey Farkas19Jeffrey Farkas20Jeffrey Farkas21Jeffrey Farkas22Thambirajah Nandakumar23Ting Zhou24Jennnifer Frontera25David E. Kahn26Sun Kim27Kelly A. Humbert28Matthew D. Sanger29Shadi Yaghi30Aaron Lord31Karthikeyan Arcot32Karthikeyan Arcot33Karthikeyan Arcot34Karthikeyan Arcot35Adam A. Dmytriw36Interventional Neuro Associates, Greenvale, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesJamaica Hospital Medical Center, Richmond Hill, NY, United StatesBrookdale University Hospital and Medical Center, Brooklyn, NY, United StatesInterventional Neuro Associates, Greenvale, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesJamaica Hospital Medical Center, Richmond Hill, NY, United StatesBrookdale University Hospital and Medical Center, Brooklyn, NY, United StatesBrookdale University Hospital and Medical Center, Brooklyn, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesJamaica Hospital Medical Center, Richmond Hill, NY, United StatesInterventional Neuro Associates, Greenvale, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesJamaica Hospital Medical Center, Richmond Hill, NY, United StatesBrookdale University Hospital and Medical Center, Brooklyn, NY, United StatesInterventional Neuro Associates, Greenvale, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesJamaica Hospital Medical Center, Richmond Hill, NY, United StatesBrookdale University Hospital and Medical Center, Brooklyn, NY, United StatesInterventional Neuro Associates, Greenvale, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesJamaica Hospital Medical Center, Richmond Hill, NY, United StatesBrookdale University Hospital and Medical Center, Brooklyn, NY, United StatesJamaica Hospital Medical Center, Richmond Hill, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesInterventional Neuro Associates, Greenvale, NY, United StatesLangone Medical Center, New York University, New York, NY, United StatesJamaica Hospital Medical Center, Richmond Hill, NY, United StatesBrookdale University Hospital and Medical Center, Brooklyn, NY, United StatesNeuroradiology & Neurointervention Service, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United StatesObjective: To describe the ischemic stroke subtypes related to coronavirus disease 2019 (COVID-19) in a cohort of New York City hospitals and explore their etiopathogenesis.Background: Most neurological manifestations are non-focal, but few have reported the characteristics of ischemic strokes or investigated its pathophysiology.Methods: Data were collected prospectively April 1-April 15, 2020 from two centers in New York City to review possible ischemic stroke types seen in COVID-19-positive patients. Patient presentation, demographics, related vascular risk factors, associated laboratory markers, as well as imaging and outcomes were collected.Results: The age of patients ranged between 27 and 82 years. Approximately 81% of patients had known vascular risk factors, the commonest being hypertension (75%) followed by diabetes (50%) coronary disease or atrial fibrillation. Eight patients presented with large vessel occlusion (LVO) with median age 55 years (27-82) and all were male. Eight patients presented with non-LVO syndromes, with median age 65.5 years (59–82) and most were female (62.5%). Both groups were 50% African Americans and 37.5% South Asian. Both groups had similar D-dimer levels although other acute phase reactants/disease severity markers (Ferritin, CRP, procalcitonin) were higher in the LVO group. The LVO group also had a significantly higher mortality compared to the non-LVO group. The most common etiology was cryptogenic (6 patients) followed by small vessel occlusion (3 patients) and undetermined-unclassified (3 patients). For the remaining 4 patients, 2 were identified as cardioembolic and 2 with large artery atherosclerosis.Conclusion: COVID-19-related ischemic events can present as small vessel occlusions, branch emboli or large vessel occlusions. The most common etiology is cryptogenic. Patients with LVO syndromes tend to be younger, male and may have elevated acute inflammatory markers.https://www.frontiersin.org/article/10.3389/fneur.2020.01004/fullCOVID-19acute ischemic strokesemergent large vessel occlusionmechanical thrombectomyischemic stroke |
| spellingShingle | Ambooj Tiwari Ambooj Tiwari Ambooj Tiwari Ambooj Tiwari Ketevan Berekashvili Ketevan Berekashvili Ketevan Berekashvili Ketevan Berekashvili Volodomyr Vulkanov Shashank Agarwal Amit Khaneja David Turkel-Parella David Turkel-Parella David Turkel-Parella David Turkel-Parella Jeremy Liff Jeremy Liff Jeremy Liff Jeremy Liff Jeffrey Farkas Jeffrey Farkas Jeffrey Farkas Jeffrey Farkas Thambirajah Nandakumar Ting Zhou Jennnifer Frontera David E. Kahn Sun Kim Kelly A. Humbert Matthew D. Sanger Shadi Yaghi Aaron Lord Karthikeyan Arcot Karthikeyan Arcot Karthikeyan Arcot Karthikeyan Arcot Adam A. Dmytriw Etiologic Subtypes of Ischemic Stroke in SARS-CoV-2 Patients in a Cohort of New York City Hospitals Frontiers in Neurology COVID-19 acute ischemic strokes emergent large vessel occlusion mechanical thrombectomy ischemic stroke |
| title | Etiologic Subtypes of Ischemic Stroke in SARS-CoV-2 Patients in a Cohort of New York City Hospitals |
| title_full | Etiologic Subtypes of Ischemic Stroke in SARS-CoV-2 Patients in a Cohort of New York City Hospitals |
| title_fullStr | Etiologic Subtypes of Ischemic Stroke in SARS-CoV-2 Patients in a Cohort of New York City Hospitals |
| title_full_unstemmed | Etiologic Subtypes of Ischemic Stroke in SARS-CoV-2 Patients in a Cohort of New York City Hospitals |
| title_short | Etiologic Subtypes of Ischemic Stroke in SARS-CoV-2 Patients in a Cohort of New York City Hospitals |
| title_sort | etiologic subtypes of ischemic stroke in sars cov 2 patients in a cohort of new york city hospitals |
| topic | COVID-19 acute ischemic strokes emergent large vessel occlusion mechanical thrombectomy ischemic stroke |
| url | https://www.frontiersin.org/article/10.3389/fneur.2020.01004/full |
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