Ischemic stroke in consecutive patients with COVID-19: A case-control study of clinical features, mechanisms and outcome in the swiss stroke registry

Background and Aims: Most case series of patients with ischemic stroke (IS) and COVID-19 are limited to random centers or lack 3-month outcome. The aim of this study is to describe prevalence, clinical, radiological and pathophysiological features and long-term outcome of COVID-19-related IS in a nationwide stroke registry. Methods: From the Swiss Stroke Registry (SSR), we included all consecutive IS patients aged ≥18 years who were admitted to stroke units during the first wave of COVID-19 (25.02.-08.06.2020). We compared baseline features, stroke etiology and 3-month outcome (modified Rankin shift) of COVID PCR+ IS patients with COVID PCR-and/or asymptomatic non-tested IS patients. Results: Of the 2376 IS patients entered in the SSR during the study period, 36 (1.5%) had confirmed COVID-19 infection (details in Figure 1). In multivariate analysis, COVID+ patients had lower admission blood pressure (p=0.004) and more frequently lesions in multiple vascular territories (p=0.09). Stroke seemed more often related to several defined etiologies (p=0.07), and less often to large artery atherosclerotic (p=0.07) and cryptogenic mechanisms (p=0.03). There was a strong trend towards worse outcome in COVID+ patients across the entire Rankin-spectrum (Figure 2) despite adjustment for age, stroke severity and revascularization treatments (OR 1.97, 95%CI 0.92-4.21, p=0.08). Conclusions: In this nationwide analysis of consecutive ischemic strokes, concomitant COVID-19 was relatively rare. COVID+ patients more often had multiple territory involvement and multiple stroke mechanisms, and their 3-month outcome was worse across the entire Rankin spectrum. (Table Presented).