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Advanced Neurology AIS in patients with COVID-19

Pezzini et al. found that patients with COVID-19 had to elucidate the precise pathophysiological mechanism of
suboptimal collateral status , which may also contribute cerebrovascular disease in patients with COVID-19 and
[20]
to the poor prognosis in these patients. best management.
Only a few studies have reported 90-day functional Funding
outcome, making it difficult to draw conclusions in this
meta-analysis. Martí-Fàbregas et al. concluded that 90-day This research was supported by the National Natural
functional outcome was comparable in patients with and Science Foundation of China (No. 82071304 and 81671149
without COVID-19 , whereas a recent study demonstrated to Qingxiu Zhang).
[35]
that 3-month outcome tended to be worse in patients
with COVID-19 . Additional well-designed studies are Conflict of interest
[66]
warranted to investigate functional outcomes beyond The authors declare that they have no conflicts of interest.
3 months and factors contributing to long-term outcomes.
Our study has notable strengths. The large sample size Author contributions
and worldwide geographic coverage means that the findings Conceptualization: Qingxiu Zhang, Liqun Zhang
of this meta-analysis have good generalizability. To minimize Data curation: Zhelv Yao, Yue Cheng, Ruowen Qi, Lili Huang
risk of bias, we restricted our meta-analysis to cohort, case-
control, and cross-sectional studies with a large sample size Formal analysis: Zhelv Yao, Biyun Xu, Lili Huang
and with low to moderate risk of bias based on strict quality Funding acquisition: Qingxiu Zhang
assessment criteria. Our comparative data on patients with Methodology: Zhelv Yao, Biyun Xu, Yue Cheng
COVID-19 and AIS as well as patients without COVID-19
allow for clearer inferences regarding the impact of COVID- Supervision: Qingxiu Zhang, Liqun Zhang
19 on the manifestations and outcomes of patients with AIS. Writing–original draft: Zhelv Yao
Furthermore, we summarized data based on patients with
AIS who received acute revascularization treatment and Writing–review & editing: Qingxiu Zhang, Liqun Zhang
laboratory data in the context of COVID-19, which have not References
been explored in previous reviews.
1. World Health Organization. WHO Coronavirus
Several potential limitations should also be noted. (COVID-19) Dashboard WHO Coronavirus (COVID-19)
First, potential confounding variables may lead to an Dashboard with Vaccination Data. Geneva: World Health
overestimation of association because we used unadjusted Organization; 2021.
estimates for the meta-analysis. Second, we cannot fully
exclude the possibility that there may be overlapping of some 2. Benussi A, Pilotto A, Premi E, et al., 2002, Clinical
characteristics and outcomes of inpatients with neurologic
patients across the included studies. Third, the small number disease and COVID-19 in Brescia, Lombardy, Italy.
of events may reduce the reliability of some estimates. Neurology, 95(7): e910–e920.
Fourth, the studies included in this analysis demonstrated
significant methodological heterogeneity, although we tried https://doi.org/10.1212/WNL.0000000000009848
to mitigate this using random-effects models; this should be 3. Lodigiani C, Iapichino G, Carenzo L, et al., 2020, Venous
considered when interpreting our results. Finally, because and arterial thromboembolic complications in COVID-19
the follow-up duration for most included studies was short, paients admitted to an academic hospital in Milan, Italy.
long-term functional outcomes remain to be determined. Thromb Res, 191: 9–14.
https://doi.org/10.1016/j.thromres.2020.04.024
5. Conclusions
4. Li Y, Li M, Wang M, et al., 2020, Acute cerebrovascular
This systematic review and meta-analysis showed that disease following COVID-19: A single center, retrospective,
patients with AIS who had COVID-19 infection tended observational study. Stroke Vasc Neurol, 5(3): 279–284.
to have cryptogenic LVO and multi-territory infarcts https://doi.org/10.1136/svn-2020-000431
with high CRP and D-dimer levels. These patients had
more severe stroke syndromes, worse functional outcome, 5. Ntaios, G., Michel P, Georgiopoulos G, et al., 2020,
and a higher in-hospital mortality rate, with or without Characteristics and outcomes in patients with COVID-19
and acute ischemic stroke: The global COVID-19 stroke
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that vigilance regarding stroke is needed in patients
with severe COVID-19 infection as well as a need for https://doi.org/10.1161/STROKEAHA.120.031208
antithrombotic treatment. Further studies are required 6. Sasanejad, P., Afshar Hezarkhani L, Arsang-Jang S, et al.,

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