Frontiers in Cardiovascular Medicine (Jan 2023)

SARS-CoV-2 infection predicts larger infarct volume in patients with acute ischemic stroke

  • Manuela De Michele,
  • Svetlana Lorenzano,
  • Paola Piscopo,
  • Roberto Rivabene,
  • Alessio Crestini,
  • Antonio Chistolini,
  • Lucia Stefanini,
  • Fabio M. Pulcinelli,
  • Irene Berto,
  • Roberta Campagna,
  • Paolo Amisano,
  • Marta Iacobucci,
  • Carlo Cirelli,
  • Anne Falcou,
  • Ettore Nicolini,
  • Oscar G. Schiavo,
  • Danilo Toni

DOI
https://doi.org/10.3389/fcvm.2022.1097229
Journal volume & issue
Vol. 9

Abstract

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Background and purposeAcute ischemic stroke (AIS) is a fearful complication of Coronavirus Disease-2019 (COVID-19). Aims of this study were to compare clinical/radiological characteristics, endothelial and coagulation dysfunction between acute ischemic stroke (AIS) patients with and without COVID-19 and to investigate if and how the SARS-CoV-2 spike protein (SP) was implicated in triggering platelet activation.MethodsWe enrolled AIS patients with COVID-19 within 12 h from onset and compared them with an age- and sex-matched cohort of AIS controls without COVID-19. Neuroimaging studies were performed within 24 h. Blood samples were collected in a subset of 10 patients.ResultsOf 39 AIS patients, 22 had COVID-19 and 17 did not. Admission levels of Factor VIII and von Willebrand factor antigen were significantly higher in COVID-19 patients and positively correlated with the infarct volume. In multivariate linear regression analyses, COVID-19 was an independent predictor of infarct volume (B 20.318, Beta 0.576, 95%CI 6.077–34.559; p = 0.011). SP was found in serum of 2 of the 10 examined COVID-19 patients. Platelets from healthy donors showed a similar degree of procoagulant activation induced by COVID-19 and non-COVID-19 patients' sera. The anti-SP and anti-FcγRIIA blocking antibodies had no effect in modulating platelet activity in both groups.ConclusionsSARS-CoV-2 infection seems to play a major role in endothelium activation and infarct volume extension during AIS.

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