{"doi":"10.1161/strokeaha.120.031971","title":"Ischemic Stroke, Inflammation, and Endotheliopathy in COVID-19 Patients","abstract":"Background and Purpose: Reports indicate an increased risk of ischemic stroke during coronavirus disease 2019 (COVID-19) infection. We aimed to identify patients with COVID-19 and ischemic stroke and explore markers of inflammation, hypercoagulability, and endotheliopathy, a structural and functional disturbance of the vascular endothelium due to a stressor. Methods: This was a retrospective, observational cohort study comparing acute ischemic stroke patients with and without COVID-19 across 3 hospitals. Timing of stroke onset during COVID-19 course and markers of inflammation, hypercoagulability, and endothelial activation were evaluated by COVID-19 status and stroke cause. Results: Twenty-one patients with ischemic stroke were diagnosed with COVID-19 during the study period. Patients with COVID-19 had a similar age and burden of vascular risk factors compared with the control cohort (n=168). We identified a temporal correlation between stroke onset and the peak of acute phase reactants, including CRP (C-reactive protein), ferritin, and d-dimer. In subsets of patients with labs available, embolic stroke of undetermined source was associated with elevated IL (interleukin)-6 (median, 171 [interquartile range, 13–375] versus 8 [4–11], P <0.01) and sIL (soluble IL)-2 receptor (1972 [1525–4720] versus 767 [563–1408.5], P =0.05) levels. Stroke patients with COVID-19 demonstrated elevated levels of endothelial activation markers compared with non-COVID-19 stroke controls (median von Willebrand activity 285.0% [interquartile range, 234%–382%] versus 150% [128%–183%], P =0.034; von Willebrand antigen 330.0% [265%–650%] versus 152% [130%–277%], P =0.007, and factor VIII 301% [289%–402%] versus 49% [26%–94%], P <0.001). Conclusions: Ischemic stroke in patients with COVID-19 is associated with endotheliopathy and a systemic inflammatory response in patients with vascular risk factors. Further research evaluating endothelial and inflammatory markers in the setting of ischemic stroke and COVID-19 in larger, prospective cohorts is needed to validate the findings.","journal":"Stroke","year":2021,"id":157193,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":51,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9253,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":520478,"name":"Adeel Zubair","orcid":"0000-0002-9809-7888","position":1,"is_corresponding":false},{"id":664203,"name":"Ilavarasy Maran","orcid":null,"position":2,"is_corresponding":false},{"id":664204,"name":"Pola Chojecka","orcid":null,"position":3,"is_corresponding":false},{"id":663517,"name":"Paul Lleva","orcid":"0000-0001-5658-3071","position":4,"is_corresponding":false},{"id":413178,"name":"Adam Jasne","orcid":"0000-0001-9092-3607","position":5,"is_corresponding":false},{"id":425866,"name":"Dhasakumar Navaratnam","orcid":"0000-0002-5431-8191","position":6,"is_corresponding":false},{"id":434039,"name":"Charles Matouk","orcid":"0000-0003-3234-9541","position":7,"is_corresponding":false},{"id":466302,"name":"Joseph Schindler","orcid":null,"position":8,"is_corresponding":false},{"id":256547,"name":"Kevin N. Sheth","orcid":"0000-0003-2003-5473","position":9,"is_corresponding":false},{"id":106681,"name":"Hyung J. Chun","orcid":"0000-0003-3508-2678","position":10,"is_corresponding":false},{"id":106682,"name":"Alfred Ian Lee","orcid":"0000-0002-5968-3948","position":11,"is_corresponding":false},{"id":69477,"name":"Serena Spudich","orcid":"0000-0001-6032-3950","position":12,"is_corresponding":false},{"id":467224,"name":"Richa Sharma","orcid":"0000-0003-0798-2353","position":13,"is_corresponding":false},{"id":287567,"name":"Lauren Sansing","orcid":"0000-0002-6898-1680","position":14,"is_corresponding":false},{"id":520477,"name":"Lindsay McAlpine","orcid":"0000-0003-3652-5645","position":0,"is_corresponding":true}],"reference_count":15,"raw_metadata":null,"created_at":"2026-07-18T23:44:17.471040Z","pmid":"33966492","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}