Association of COVID-19 With Large Vessel Occlusion Strokes:
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An increase in frequency of acute ischemic strokes has been observed among patients presenting with acute neurologic symptoms during the COVID-19 pandemic.

This retrospective case-control study aimed to investigate the association between COVID-19 and stroke subtypes in patients presenting with acute neurologic symptoms Demographic data (age, sex, and race or ethnicity), COVID-19 status, stroke-related risk factors, and clinical and imaging findings pertaining to stroke were collected.

-- The study sample consisted of 329 patients for whom a code for stroke was activated.
-- Among the 329 patients, 35.3% had acute ischemic stroke confirmed with imaging; 21.6% had large vessel occlusion (LVO) stroke; and 14.6% had small vessel occlusion (SVO) stroke.
-- Among LVO strokes, the most common location was middle cerebral artery segments M1 and M2 (62.0%).
-- Multifocal LVOs were present in 9.9% of LVO strokes.
-- COVID-19 was present in 38.3% of the patients.
-- The 61.7% of patients without COVID-19 formed the negative control group.
-- Among individual stroke-related risk factors, only Hispanic ethnicity was significantly associated with COVID-19.
-- LVO was present in 31.7% of patients with COVID-19 compared with 15.3% of patients without COVID-19.
-- SVO was present in 15.9% of patients with COVID-19 and 13.8% of patients without COVID-19.
-- In multivariate analysis controlled for race and ethnicity, presence of COVID-19 had a significant independent association with LVO stroke compared with absence of COVID-19.

Conclusively, COVID-19 is associated with LVO strokes but not with SVO strokes. Therefore, Patients with COVID-19 presenting with acute neurologic symptoms warrant a lower threshold for suspicion of large vessel stroke, and prompt workup for large vessel stroke is recommended.

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