COVID-19 and ischemic stroke: A systematic review and meta-summary of the literature

Background: Acute ischemic stroke (AIS) is a life-threatening complication of coronavirus disease 2019 (COVID-19) infection Increasing reports suggest an association between COVID-19 and AIS, although the underlying mechanism remains uncertain Objectives: We performed a systematic review to characterize the clinical characteristics, neuroimaging findings, and outcomes of AIS in COVID-19 patients Methods: A literature search was performed in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 29th May 2020 All studies reporting AIS occurrence in COVID-19 patients were included Results: A total of 39 studies comprising 135 patients were studied The pooled incidence of AIS in COVID-19 patients from observational studies was 1 2% (54/4466) with a mean age of 63 4 ± 13 1 years The mean duration of AIS from COVID-19 symptoms onset was 10 ± 8 days, and the mean NIHSS score was 19 ± 8 Laboratory investigations revealed an elevated mean D-dimer (9 2 ± 14 8 mg/L) and fibrinogen (5 8 ± 2 0 g/L) Antiphospholipid antibodies were detected in a significant number of cases The majority of AIS neuroimaging patterns observed was large vessel thrombosis, embolism or stenosis (62 1%, 64/103), followed by multiple vascular territory (26 2%, 27/103) A high mortality rate was reported (38 0%, 49/129) Conclusion: We report the pooled incidence of AIS in COVID-19 patients to be 1 2%, with a high mortality rate Elevated D-dimer, fibrinogen and the presence of antiphospholipid antibodies appear to be prominent in COVID-19 patients with concomitant AIS, but further mechanistic studies are required to elucidate their role in pathogenesis