@article{2987368,
    title = "SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group",
    author = "Shahjouei, S. and Tsivgoulis, G. and Farahmand, G. and Koza, E. and Mowla, A. and Vafaei Sadr, A. and Kia, A. and Vaghefi Far, A. and Mondello, S. and Cernigliaro, A. and Ranta, A. and Punter, M. and Khodadadi, F. and Naderi, S. and Sabra, M. and Ramezani, M. and Amini Harandi, A. and Olulana, O. and Chaudhary, D. and Lyoubi, A. and Campbell, B.C.V. and Arenillas, J.F. and Bock, D. and Montaner, J. and Aghayari Sheikh Neshin, S. and Aguiar De Sousa, D. and Tenser, M.S. and Aires, A. and Alfonso, M.D.L. and Alizada, O. and Azevedo, E. and Goyal, N. and Babaeepour, Z. and Banihashemi, G. and Bonati, L.H. and Cereda, C.W. and Chang, J.J. and Crnjakovic, M. and De Marchis, G.M. and Del Sette, M. and Ebrahimzadeh, S.A. and Farhoudi, M. and Gandoglia, I. and Goncąlves, B. and Griessenauer, C.J. and Murat Hanci, M. and Katsanos, A.H. and Krogias, C. and Leker, R.R. and Lotman, L. and Mai, J. and Male, S. and Malhotra, K. and Malojcic, B. and Mesquita, T. and Mir Ghasemi, A. and Mohamed Aref, H. and Mohseni Afshar, Z. and Moon, J. and Niemelä, M. and Rezai Jahromi, B. and Nolan, L. and Pandhi, A. and Park, J.-H. and Marto, J.P. and Purroy, F. and Ranji-Burachaloo, S. and Carreira, N.R. and Requena, M. and Rubiera, M. and Sajedi, S.A. and Sargento-Freitas, J. and Sharma, V.K. and Steiner, T. and Tempro, K. and Turc, G. and Ahmadzadeh, Y. and Almasi-Dooghaee, M. and Assarzadegan, F. and Babazadeh, A. and Baharvahdat, H. and Cardoso, F.B. and Dev, A. and Ghorbani, M. and Hamidi, A. and Hasheminejad, Z.S. and Hojjat-Anasri Komachali, S. and Khorvash, F. and Kobeissy, F. and Mirkarimi, H. and Mohammadi-Vosough, E. and Misra, D. and Noorian, A.R. and Nowrouzi-Sohrabi, P. and Paybast, S. and Poorsaadat, L. and Roozbeh, M. and Sabayan, B. and Salehizadeh, S. and Saberi, A. and Sepehrnia, M. and Vahabizad, F. and Yasuda, T.A. and Ghabaee, M. and Rahimian, N. and Harirchian, M.H. and Borhani-Haghighi, A. and Azarpazhooh, M.R. and Arora, R. and Ansari, S. and Avula, V. and Li, J. and Abedi, V. and Zand, R.",
    journal = "ISRN Stroke",
    year = "2021",
    publisher = "Lippincott Williams and Wilkins",
    issn = "2090-9454",
    doi = "10.1161/STROKEAHA.120.032927",
    keywords = "adult;  aged;  brain hemorrhage;  brain ischemia;  cerebral sinus thrombosis;  clinical trial;  complication;  female;  geography;  health care cost;  human;  international cooperation;  male;  middle aged;  multicenter study;  prospective study;  risk;  treatment outcome;  vein thrombosis;  young adult, Adult;  Aged;  COVID-19;  Female;  Geography;  Health Expenditures;  Humans;  International Cooperation;  Intracranial Hemorrhages;  Ischemic Stroke;  Male;  Middle Aged;  Prospective Studies;  Risk;  Sinus Thrombosis, Intracranial;  Treatment Outcome;  Venous Thrombosis;  Young Adult",
    abstract = "Background and Purpose: Stroke is reported as a consequence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in several reports. However, data are sparse regarding the details of these patients in a multinational and large scale. Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke, intracranial hemorrhage, and cerebral venous or sinus thrombosis among SARS-CoV-2-infected patients. We further investigated the risk of large vessel occlusion, stroke severity as measured by the National Institutes of Health Stroke Scale, and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with acute ischemic stroke. In addition, we explored the neuroimaging findings, features of patients who were asymptomatic for SARS-CoV-2 infection at stroke onset, and the impact of geographic regions and countries' health expenditure on outcomes. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least 1 eligible stroke patient. Of 432 patients included, 323 (74.8%) had acute ischemic stroke, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis. A total of 183 (42.4%) patients were women, 104 (24.1%) patients were <55 years of age, and 105 (24.4%) patients had no identifiable vascular risk factors. Among acute ischemic stroke patients, 44.5% (126 of 283 patients) had large vessel occlusion; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median National Institutes of Health Stroke Scale (8 [3-17] versus 11 [5-17]; P=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; P<0.001) in countries with middle-to-high health expenditure when compared with countries with lower health expenditure. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144 (37.8%) were asymptomatic at the time of admission for SARS-CoV-2 infection. Conclusions: We observed a considerably higher rate of large vessel occlusions, a much lower rate of small vessel occlusion and lacunar infarction, and a considerable number of young stroke when compared with the population studies before the pandemic. The rate of mechanical thrombectomy was significantly lower in countries with lower health expenditures. © 2021 Lippincott Williams and Wilkins. All rights reserved."
}