Early Brain Imaging Shows Increased Severity of Acute Ischemic Strokes With Large Vessel Occlusion in COVID-19 Patients

Simon Escalard, MD; Vanessa Chalumeau, MD; Clément Escalard, MD; Hocine Redjem, MD; François Delvoye, MD; Solène Hébert, MD; Stanislas Smajda, MD; Gabriele Ciccio, MD; Jean-Philippe Desilles, MD, PhD; Mikael Mazighi, MD, PhD; Raphael Blanc, MD; Benjamin Maïer, MD; Michel Piotin, MD, PhD


Stroke. 2020;51(11):3366-3370. 

In This Article


According to the Transparency and Openness Promotion Guidelines, the authors declare that the data which support the findings of this study are available from the corresponding author upon reasonable request. Our local ethics committee approved the use of patient data for this research protocol. In accordance with French legislation, informed consent was not needed from patients because this study analyzed anonymized data collected prospectively as a part of routine clinical care.

Patients Selection

All consecutive early diagnosed aLVO with real-time polymerase chain reaction confirmed COVID-19 treated in our institution between March 15, 2020 and April 30, 2020 were included. For the purpose of investigating the potentially higher severity of aLVO in patients with COVID-19, patients with late diagnosis (first imaging later than 3 hours from onset), or unknown onset were excluded.

As stroke patients were not systematically screened with real-time polymerase chain reaction during this time period, patients with unknown status regarding COVID-19 were excluded, and the comparative control cohort was constituted with early diagnosed aLVO treated in our institution during the same calendar period in 2019.

Imaging Analysis

All imaging data were prospectively gathered, at the exception of infarct core volumes. Multivessel occlusion was defined as a simultaneous occlusion of the middle cerebral artery and either the anterior or the posterior cerebral artery. Two authors (Drs Chalumeau and C. Escalard) blinded to the COVID-19 status (and time of acquisition) of the cases were asked to independently measure the infarct core volume[6] for all patients, on a b1000 diffusion-weighted imaging sequence, using Food and Drug Administration– and Conformité Européenne–cleared software Osirix MD (Pixmeo, Geneva, Switzerland). In cases of discordance, a simultaneous reading to reach consensus was achieved.

Statistical Analysis

Comparisons between the 2 study groups were made using the Student t test for gaussian continuous variables, the Mann-Whitney U test for nongaussian continuous variables, and the χ 2 (or Fisher exact test when the expected cell frequency was <5) for categorical variables, as appropriate. All analyses were done with R software V.3.3.2 and a significance level of 5%.