PT - JOURNAL ARTICLE AU - S. John AU - P. Kesav AU - V.A. Mifsud AU - B. Piechowski-Jozwiak AU - J. Dibu AU - A. Bayrlee AU - H. Elkambergy AU - F. Roser AU - M.S. Elhammady AU - K. Zahra AU - S.I. Hussain TI - Characteristics of Large-Vessel Occlusion Associated with COVID-19 and Ischemic Stroke AID - 10.3174/ajnr.A6799 DP - 2020 Aug 27 TA - American Journal of Neuroradiology 4099 - http://www.ajnr.org/content/early/2020/08/27/ajnr.A6799.short 4100 - http://www.ajnr.org/content/early/2020/08/27/ajnr.A6799.full AB - SUMMARY: The mechanisms and phenotype of ischemic stroke associated with coronavirus disease 2019 (COVID-19) remain uncertain. A retrospective study was conducted in patients with COVID-19 presenting with ischemic stroke from March 1 to May 25, 2020, and cases with large-vessel occlusion were identified. To provide baseline institutional stroke data within and outside the COVID-19 pandemic, all consecutive ischemic stroke and TIA admissions (COVID and non-COVID) to the hospital during a 10-week period from March 1 to May 10, 2020, were collected and compared with data from the same time period in 2019. Among 20 patients with COVID-19 and acute ischemic stroke, 15 (75%) had large-vessel occlusion. These patients were young (mean age, 46.5 years), male (93%), without major burden of traditional cardiovascular risk factors, and had a severe stroke presentation. Large-vessel occlusions were observed in multiple vessels (40%), uncommonly affected vessels, and atypical locations with a large thrombus burden. Systemic thrombosis separate from large-vessel occlusion was not uncommon (26%). At short-term follow-up, stroke etiology remained undetermined in 46% of patients and functional outcome was poor. The above findings raise the possibility of stroke related to mechanisms induced by the COVID-19 infection itself, including a hypercoagulable state and/or endothelial damage. In addition, they document the severe presentation and poor outcomes of large-vessel occlusion in COVID-19 ischemic stroke.CCAcommon carotid arteryCOVID-19coronavirus disease 2019LVOlarge-vessel occlusionSARS CoV-2Severe Acute Respiratory Syndrome coronavirus-2