Large-Vessel Occlusion Stroke Associated with Covid-19: A Systematic Review and Meta-Analysis of Outcomes

Abstract

Background SARS-CoV-2 induced respiratory illness is increasingly being recognized to be associated with neurological manifestations including an increase in the incidence of strokes, particularly those induced by large vessel occlusion (LVO). Given this, the aim of present study was to determine the influence of SARS-CoV-2 i.e. Coronavirus disease-19 (COVID-19) on mortality, neurological outcomes, and treatment response in patients with stroke due to large vessel occlusion induced by COVID-19.Methods A search of randomized controlled trials (RCTs), prospective and retrospective cohort studies was conducted through PUBMED, SCOPUS, MEDLINE, EMBASE, the Central Cochrane Registry of Controlled Trials, and CINAHL databases. The statistical analysis was performed using the relative risk with the Mantel-Haenszel methodology for dichotomous variables with a fixed-effects model. The Newcastle-Ottawa scale (NOS) was used to assess the quality of the publications and ROBINS-I tool was used to evaluate the risk of bias across the studies.Results Six retrospective observational cohort and case-control studies involving 1000 patients with LVO were included. The group of COVID 19 patients with LVO had a greater risk of mortality(OR= 7.09, [95% CI: 4.6-10.91], I2= 0%, p = <0.00001), fewer rates of treatment success(OR 0.15 [95% CI 0.08-0.29], I2 = 49%, p = <0.00001), and lower favorable outcomes (OR 0.39 [95% CI 0.16-0.96], I2 = 63%, p = 0.04) than COVID 19 negative patients with LVO.Conclusion The findings from present systematic review suggest that patients with COVID 19 and LVO stroke have higher mortality and poorer outcomes than COVID 19 negative patients with LVO stroke.