Abstract Body: Introduction: In patients with severe COVID-19 infection there is an increased risk of cerebrovascular events, including acute ischemic stroke (AIS). In patients who present with COVID-19 infection and AIS, certain stroke subtypes have been reported with greater frequency. The objective of this study was to determine differences in patient demographics and stroke sub-type by COVID status at a US comprehensive stroke center.

Methods: We retrospectively evaluated adults (≥18) with AIS admitted during the first year of the COVID pandemic (3/1/2020 – 3/1/2021). Demographics (age, sex, race, comorbidities with ≥5% incidence), stroke subtype (TOAST classification), severity (NIHSS), management (intravenous and intraarterial therapy [IVT and IAT]), and outcomes (in-hospital mortality and discharge modified Rankin scale [mRS]) were compared for patients who were COVID+ vs COVID– using Pearson chi-square tests.

Results: Among 1,086 AIS patients, 475 (44%) were evaluated for COVID-19 infection during their inpatient stay. Most patients (94%) had PCR testing. Thirty-five (7%) patients were COVID+ and 441 (93%) were COVID–. There were significant differences in study covariates by COVID status, table 1. COVID+ patients had a greater proportion of cryptogenic strokes (62% vs. 32%, p<0.001), were more likely to report previous COVID infection (19% vs. 2%, p<0.001), were more likely to receive IVT (41% vs. 24%, p=0.03), and were less likely to be non-Hispanic white (53% vs. 71%, p=0.02) compared to COVID– patients. In-hospital mortality was significantly greater in COVID+ versus COVID– patients (12% vs. 4%, p=0.03); however, discharge mRS was not significantly different (p=0.08). When comparing symptomatic (n=10) and asymptomatic (n=24) COVID+ patients, symptomatic patients were more likely to present with severe stroke (NIHSS ≥21: 41% vs. 0%, p=0.03) and worse mRS (independent [0-2]: 17% vs. 60%, p=0.04); there were no other demographic or clinical differences by symptomatology.

Discussion: In the setting of a widespread pandemic such as COVID-19, stroke etiology, severity, and clinical outcomes can differ significantly based on COVID status. These data suggest that patients with AIS and COVID were more likely to have cryptogenic stroke, higher mortality, and, in the case of symptomatic COVID, worse stroke severity and neurologic disability at discharge.