Table 2.
Patients with non large vessel occlusion (LVO) syndromes.
| Characteristics of patients with non-LVO syndromes | ||||||||
| Patient ID | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 |
| Demographics and vascular history | ||||||||
| Age | 82 | 59 | 80 | 74 | 60 | 62 | 64 | 67 |
| Sex | Male | Female | Female | Female | Female | Male | Female | Male |
| Race | African American | Hispanic | African American | African American | African American | South Asian | South Asian | South Asian |
| Vascular risk factors (description) | DM, HTN, CVA, CKD | None* | DM, HTN | DM, HTN | DM, HTN, CVA, CKD | HTN, CAD, CHF | HTN | HTN |
| COVID history | ||||||||
| COVID symptoms | Cough | Fever, Cough, Chills | Hypoxia | Cough, Chills | Cough, Chills | Fever, Cough, Dyspnea | Fever, Cough, Chills | Fever, Cough |
| COVID treatment | Ceftriaxone, AZT | Ceftriaxone, AZT, Remdesivir | HCQ, Ceftriaxone | HCQ, AZT | None | Ribavirin | HCQ, AZT | Ceftriaxone, AZT |
| Other systemic disease | AKI | Septic shock | AKI | NSTEMI | ||||
| Stroke history and acute imaging | ||||||||
| LKW—symptom detection (mins) | 1,500 | 1,635 | 630 | 2,325 | 630 | 120 | 0 | 480 |
| Symptom detection -Door (mins) | 60 | 0 | 240 | 2,340 | 213 | 480 | 175 | 50 |
| NIHSS (admission) | 7 | 10 | 23 | 9 | 6 | 14 | 5 | 12 |
| CTA/MRA lesion Location | N/A | N/A | N/A | N/A | N/A | N/A | Right M1-M2/MCA stenosis | Cervical LICA Occlusion |
| Stroke therapy and prophylaxis | ||||||||
| IV tPA | N | N | N | N | N | N | Y | N |
| Stroke Prophylaxis type | AC | AC | AP | AP | AP | AP | AP | AP |
| Stroke Prophylaxis medication | UFH | LMWH | ASA | ASA | ASA | DAPT | DAPT | Eptifibatide f/b DAPT |
| Imaging and other diagnostic work Up (non-acute) | ||||||||
| CXR | Right Lower Lobe infiltrates | B/L diffuse patchy opacities | B/L diffuse infiltrates | Right Lung infiltrates | Clear | Clear | B/L diffuse opacities | B/L patchy infiltrates |
| Ejection fraction | 60% | N/A | N/A | N/A | N/A | 10–15% | N/A | N/A |
| Other echo abnormalities | Moderate LV Wall thickening | N/A | N/A | N/A | Hyper-dynamic LV | Global LV hypokinesis/ dilatation |
N/A | N/A |
| MRI brain (Follow-up infarcts) | Embolic post left frontal cortex | Multiple vascular territory embolic infarcts | N/A | Thalamo-capsular | Negative | Left Putamen, small right subcortical | N/A | Left Parieto-occipital watershed |
| CT head (Follow-up infarcts) | N/A | N/A | Internal capsule and Ganglionic infarction | N/A | Right internal capsule infarction | N/A | Right hemispheric infarction | N/A |
| Outcome and etiology | ||||||||
| Etiology | Undetermined: Crypto | Undetermined: Unclassified** | SVO: Evident | SVO: Evident | SVO: Evident | Undetermined: Unclassified*** | LAA: Prob | LAA: Prob |
| mRS at discharge | 3 | 6 | 4 | 3 | 2 | 3 | 5 | 4 |
n, number of; DM, diabetes mellitus; HTN, hypertension; CKD, Chronic Kidney Disease (Stages 4-5); CVA, cerebrovascular accident; CAD, Coronary Artery Disease; CHF, Congestive Heart Failure; d, days; Y, Yes; N, No; HCQ, hydroxychloroquine; AZT, azathioprine; AKI, Acute Kidney Injury; NSTEMI, Non ST Elevation Myocardial Infarction; N/A, Not Applicable/Available; LKW, last known well; mins, minutes; NIHSS, National Institutes of Health Stroke Score; CT, computed tomography; ASPECTS, Alberta Stroke Program Early CT Score; CTA, CT Angiography; MRA, Magnetic Resonance Angiography; M1, M1 segment of Middle Cerebral Artery; M2, M2 segment of Middle Cerebral Artery; MCA, middle cerebral artery; ICA, internal carotid artery; tPA, tissue plasminogen activator; AP, antiplatelet; AC, anticoagulation; UFH, unfractionated heparin; LMWH, low molecular weight heparin; ASA, acetylsalicylic acid; DAPT, Dual Anti-platelet Agents; f/b, followed by; NLR, neutrophil-lymphocyte ratio; WBC, white blood cell count; INR, international normalized ratio; PTT, partial thromboplastin time; CRP, c-reactive protein; LDH, lactate dehydrogenase; CPK, creatine phosphokinase; LDL, low-density lipoprotein; CXR, chest x-ray; B/L, Bilateral; LV, Left Ventricle; Crypto, Cryptogenic; SVO, Small Vessel Occlusion; LAA, Large Artery Atherosclerosis; Prob, Probable; mRS, modified Rankin scale.
Patient had multi-territorial infarcts in spite of full dose anticoagulation as well as elevated D-dimer (admission). Also, no echocardiography available. Therefore, unclassified due to incomplete work up as well as possible multiple etiologic mechanisms present.
Infarct patterns suggested SVO etiology but given presence of bilateral territory involvement and low EF, cardioembolism couldn't be ruled out completely. Since there were two putative mechanisms involved, based on the algorithm it was defined as unclassified.
Patient was obese but without documented morbidity.