Targeting of renin-angiotensin system in COVID-19 patients affected by stroke: Emerging concerns about detrimental vs. benefit effect

Sabino Luzzi; Alice Giotta Lucifero; Stefano Marasco; Mattia Del Maestro; Giuseppe Bellantoni; Cristian Gragnaniello

doi:10.1016/j.inat.2020.100822

Targeting of renin-angiotensin system in COVID-19 patients affected by stroke: Emerging concerns about detrimental vs. benefit effect

Interdiscip Neurosurg. 2020 Dec:22:100822. doi: 10.1016/j.inat.2020.100822. Epub 2020 Jul 10.

Authors

Sabino Luzzi^{1

2}, Alice Giotta Lucifero¹, Stefano Marasco¹, Mattia Del Maestro^{2

3}, Giuseppe Bellantoni², Cristian Gragnaniello⁴

Affiliations

¹ Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Polo Didattico "Cesare Brusotti", Viale Brambilla, 74 - 27100 Pavia, Italy.
² Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Viale C. Golgi, 19 - 27100 Pavia, Italy.
³ School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Polo Didattico "Cesare Brusotti", Viale Brambilla, 74 - 27100 Pavia, Italy.
⁴ Department of Neurological Surgery, University of Illinois at Chicago, 1200 W Harrison St, Chicago, IL 60607, USA.

Abstract

Objective: The present short report summarizes some clinical characteristics of six patients affected by stroke while being on angiotensin-converting enzyme (ACE)2 inhibitors and angiotensin II receptor blockers (ARBs) before and during COVID-19.

Methods: Medical charts and images of six patients affected by stroke while being on ACE-Is and ARBs therapy before and during COVID-19 outbreak in Lombardy region, Italy, were reviewed.

Results: Three patients had a dural sinus thrombosis, whereas the remaining suffered by an arterial ischemia, which was a middle cerebral artery occlusion in one case, and a posterior-inferior cerebellar artery occlusion in the remaining two. All patients showed clinical features typical of SARS-CoV-2 infection and positive chest CT scan, and were treated with ACE-Is as needed. Hypercoagulability panel was negative in any case. A recovery was achieved in all cases, although in a variable manner.

Conclusions: Whether or not and in which manner the pharmacomodulation of the renin-angiotensin system may had affect the clinical course of the reported six COVID-19 patients affected by stroke has to be still clarified. An urgent need of randomized clinical trials aimed to assess the safety profile and neuroprotective properties of ACE-Is and ARBs in COVID-19 patients diagnosed with stroke does exists.

Keywords: ACE inhibitors; Angiotensin II receptor blockers; COVID-19; Renin-angiotensin system; SARS-CoV-2; Stroke.