@article{2997248,
    title = "The Impact of SARS-CoV-2 on Stroke Epidemiology and Care: A Meta-Analysis",
    author = "Katsanos, A.H. and Palaiodimou, L. and Zand, R. and Yaghi, S. and Kamel, H. and Navi, B.B. and Turc, G. and Romoli, M. and Sharma, V.K. and Mavridis, D. and Shahjouei, S. and Catanese, L. and Shoamanesh, A. and Vadikolias, K. and Tsioufis, K. and Lagiou, P. and Alexandrov, A.V. and Tsiodras, S. and Tsivgoulis, G.",
    journal = "Annals of Neurology",
    year = "2021",
    volume = "89",
    number = "2",
    pages = "380-388",
    publisher = "John Wiley and Sons Inc",
    issn = "0364-5134, 1531-8249",
    doi = "10.1002/ana.25967",
    keywords = "fibrinolytic agent, adult;  adverse outcome;  Article;  brain hemorrhage;  brain ischemia;  cerebral sinus thrombosis;  cerebrovascular accident;  cerebrovascular disease;  clinical evaluation;  cohort analysis;  comparative study;  controlled study;  coronavirus disease 2019;  demography;  diabetes mellitus;  disease association;  fibrinolytic therapy;  historical research;  hospital mortality;  hospital patient;  human;  observational study;  pandemic;  patient care;  percutaneous thrombectomy;  prevalence;  priority journal;  prospective study;  retrospective study;  Severe acute respiratory syndrome coronavirus 2;  stroke patient;  systematic review;  case control study;  cerebrovascular accident;  comorbidity;  hospital mortality;  meta analysis;  thrombectomy, Case-Control Studies;  Comorbidity;  COVID-19;  Diabetes Mellitus;  Hospital Mortality;  Humans;  SARS-CoV-2;  Stroke;  Thrombectomy;  Thrombolytic Therapy",
    abstract = "Objective: Emerging data indicate an increased risk of cerebrovascular events with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and highlight the potential impact of coronavirus disease (COVID-19) on the management and outcomes of acute stroke. We conducted a systematic review and meta-analysis to evaluate the aforementioned considerations. Methods: We performed a meta-analysis of observational cohort studies reporting on the occurrence and/or outcomes of patients with cerebrovascular events in association with their SARS-CoV-2 infection status. We used a random-effects model. Summary estimates were reported as odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Results: We identified 18 cohort studies including 67,845 patients. Among patients with SARS-CoV-2, 1.3% (95% CI = 0.9–1.6%, I2 = 87%) were hospitalized for cerebrovascular events, 1.1% (95% CI = 0.8–1.3%, I2 = 85%) for ischemic stroke, and 0.2% (95% CI = 0.1–0.3%, I2 = 64%) for hemorrhagic stroke. Compared to noninfected contemporary or historical controls, patients with SARS-CoV-2 infection had increased odds of ischemic stroke (OR = 3.58, 95% CI = 1.43–8.92, I2 = 43%) and cryptogenic stroke (OR = 3.98, 95% CI = 1.62–9.77, I2 = 0%). Diabetes mellitus was found to be more prevalent among SARS-CoV-2 stroke patients compared to noninfected historical controls (OR = 1.39, 95% CI = 1.00–1.94, I2 = 0%). SARS-CoV-2 infection status was not associated with the likelihood of receiving intravenous thrombolysis (OR = 1.42, 95% CI = 0.65–3.10, I2 = 0%) or endovascular thrombectomy (OR = 0.78, 95% CI = 0.35–1.74, I2 = 0%) among hospitalized ischemic stroke patients during the COVID-19 pandemic. Odds of in-hospital mortality were higher among SARS-CoV-2 stroke patients compared to noninfected contemporary or historical stroke patients (OR = 5.60, 95% CI = 3.19–9.80, I2 = 45%). Interpretation: SARS-CoV-2 appears to be associated with an increased risk of ischemic stroke, and potentially cryptogenic stroke in particular. It may also be related to an increased mortality risk. ANN NEUROL 2021;89:380–388. © 2020 American Neurological Association"
}