Shima Shahjouei1, Michelle Anyaehie1, Eric Koza2, Georgios Tsivgoulis3, Soheil Naderi4, Ashkan Mowla1,5, Venkatesh Avula1, Alireza Vafaei Sadr6, Durgesh Chaudhary1, Ghasem Farahmand7, Christoph Griessenauer1,8, Mahmoud Reza Azarpazhooh9, Debdipto Misra10, Jiang Li11, Vida Abedi11,12, Ramin Zand1. 1. Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA. 2. Neuroscience Institute, Geisinger Commonwealth School of Medicine, Scranton, PA 18510, USA. 3. Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, School of Medicine, 12462 Athens, Greece. 4. Department of Neurosurgery, Tehran University of Medical Sciences, Tehran 14155-6559, Iran. 5. Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. 6. Department de Physique Theorique and Center for Astroparticle Physics, University Geneva, 1211 Geneva, Switzerland. 7. Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran 14155-6559, Iran. 8. Research Institute of Neurointervention, Paracelsus Medical University, 5020 Salzburg, Austria. 9. Department of Clinical Neurological Sciences, Western University, London, ON N6A 3K7, Canada. 10. Steele Institute of Health and Innovation, Geisinger Health System, Danville, PA 17822, USA. 11. Department of Molecular and Functional Genomics, Geisinger Health System, Danville, PA 17822, USA. 12. Biocomplexity Institute, Virginia Tech, Blacksburg, VA 24060, USA.
Abstract
BACKGROUND: SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investigated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. METHODS: This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addition, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). RESULTS: This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6-14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8-40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4-36.2) were associated with cardioembolic stroke. CONCLUSIONS: Although a cohort of young and healthy men with cardioembolic and large vessel occlusions can be distinguished using both clinical sub-grouping and unsupervised clustering, stroke in other patients may be explained based on the existing comorbidities.
BACKGROUND:SARS-CoV-2 infectedpatients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infectedpatients with subsequent stroke. We also investigated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. METHODS: This is a report from the Multinational COVID-19Stroke Study Group. We present an original dataset of SASR-CoV-2 infectedpatients who had a subsequent stroke recorded through our multicenter prospective study. In addition, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). RESULTS: This study included 323 AISpatients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6-14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8-40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4-36.2) were associated with cardioembolic stroke. CONCLUSIONS: Although a cohort of young and healthy men with cardioembolic and large vessel occlusions can be distinguished using both clinical sub-grouping and unsupervised clustering, stroke in other patients may be explained based on the existing comorbidities.
Authors: Georg Fuellen; Uwe Walter; Larissa Henze; Jan Böhmert; Daniel Palmer; Soyoung Lee; Clemens A Schmitt; Henrik Rudolf; Axel Kowald Journal: Cell Mol Neurobiol Date: 2022-08-11 Impact factor: 4.231
Authors: Davide Strambo; Gian Marco De Marchis; Leo H Bonati; Marcel Arnold; Emmanuel Carrera; Santi Galletta; Krassen Nedeltchev; Timo Kahles; Carlo W Cereda; Giovanni Bianco; Georg Kägi; Andreas R Luft; Manuel Bolognese; Lehel-Barna Lakatos; Stephan Salmen; Pamela Correia; Rolf Sturzenegger; Albert Sylvan; Friedrich Medlin; Christian Berger; Florian Lindheimer; Markus Baumgärtner; Ludwig Schelosky; Christophe Bonvin; Marie-Luise Mono; Biljana Rodic; Andrea von Reding; Guido Schwegler; Federico Massini; Alexander A Tarnutzer; Shadi Taheri; Nils Peters; Morin Beyeler; Valerian Altersberger; Stefan T Engelter; Urs Fischer; Patrik Michel Journal: Eur J Neurol Date: 2021-12-09 Impact factor: 6.288
Authors: Payam Sasanejad; Leila Afshar Hezarkhani; Shahram Arsang-Jang; Georgios Tsivgoulis; Abdoreza Ghoreishi; Kristian Barlinn; Jan Rahmig; Mehdi Farhoudi; Elyar Sadeghi Hokmabadi; Afshin Borhani-Haghighi; Payam Sariaslani; Athena Sharifi-Razavi; Kavian Ghandehari; Alireza Khosravi; Craig Smith; Yongchai Nilanont; Yama Akbari; Thanh N Nguyen; Anna Bersano; Nawaf Yassi; Takeshi Yoshimoto; Simona Lattanzi; Animesh Gupta; Ramin Zand; Shahram Rafie; Seyede Pourandokht Mousavian; Mohammad Reza Shahsavaripour; Shahram Amini; Saltanat U Kamenova; Aida Kondybayeva; Murat Zhanuzakov; Elizabeth M Macri; Christa O'Hana S Nobleza; Sean Ruland; Anna M Cervantes-Arslanian; Masoom J Desai; Annemarei Ranta; Amir Moghadam Ahmadi; Mahtab Rostamihosseinkhani; Razieh Foroughi; Etrat Hooshmandi; Fahimeh H Akhoundi; Ashfaq Shuaib; David S Liebeskind; James Siegler; Jose G Romano; Stephan A Mayer; Reza Bavarsad Shahripour; Babak Zamani; Amadene Woolsey; Yasaman Fazli; Khazaei Mojtaba; Christian F Isaac; Jose Biller; Mario Di Napoli; M Reza Azarpazhooh Journal: J Stroke Cerebrovasc Dis Date: 2021-09-20 Impact factor: 2.677