We compared digital intra-arterial angiography and transcranial Doppler sonography in acute cerebral ischemia as part of a wider study on a continuous series of 48 patients with acute focal cerebral ischemia in the carotid territory, observed within 4 hours of the onset of symptoms. T he high frequency of acute intracranial occlusion and the therapeutic use of active thrombolytic agents stress the need to monitor the patency of intracranial cerebral arteries in acute ischemic strokes.1 Noninvasive exams should represent the first choice in detecting the occurrence of intracranial arterial occlusions in the very early phase and in following their natural course and responsiveness to therapies.2 The aim of this report is to validate transcranial Doppler (TCD) with respect to cerebral angiography, when both are performed within a short interval, and to define some guidelines for interpretation of TCD findings in acute cerebral ischemia. Subjects and MethodsWe examined 48 patients (22 men, 26 women; mean age±SD, 66.2±9.7years) who had focal cerebral deficits of acute onset due to hemispheric cerebral ischemia. Clinical observation occurred within 4 hours of the onset of the stroke, and within the following 2 hours, all patients underwent a computed tomography (CT) scan, TCD, and intraarterial cerebral angiography. The last two tests were scored independently and blindly.

Background and Purpose: We aimed to investigate the rate of hospital admissions for cerebrovascular events and of revascularization treatments for acute ischemic stroke in Italy during the coronavirus disease 2019 (COVID-19) outbreak. Methods: The Italian Stroke Organization performed a multicenter study involving 93 Italian Stroke Units. We collected information on hospital admissions for cerebrovascular events from March 1 to March 31, 2020 (study period), and from March 1 to March 31, 2019 (control period). Results: Ischemic strokes decreased from 2399 in 2019 to 1810 in 2020, with a corresponding hospitalization rate ratio (RR) of 0.75 ([95% CI, 0.71–0.80] P <0.001); intracerebral hemorrhages decreased from 400 to 322 (hospitalization RR, 0.81 [95% CI, 0.69–0.93]; P =0.004), and transient ischemic attacks decreased from 322 to 196 (hospitalization RR, 0.61 [95% CI, 0.51–0.73]; P <0.001). Hospitalizations decreased in Northern, Central, and Southern Italy. Intravenous thrombolyses decreased from 531 (22.1%) in 2019 to 345 in 2020 (19.1%; RR, 0.86 [95% CI, 0.75–0.99]; P =0.032), while primary endovascular procedures increased in Northern Italy (RR, 1.61 [95% CI, 1.13–2.32]; P =0.008). We found no correlation ( P =0.517) between the hospitalization RRs for all strokes or transient ischemic attack and COVID-19 incidence in the different areas. Conclusions: Hospitalizations for stroke or transient ischemic attacks across Italy were reduced during the worst period of the COVID-19 outbreak. Intravenous thrombolytic treatments also decreased, while endovascular treatments remained unchanged and even increased in the area of maximum expression of the outbreak. Limited hospitalization of the less severe patients and delays in hospital admission, due to overcharge of the emergency system by COVID-19 patients, may explain these data.

TCD examination offers an easy and reliable way of monitoring MCA reopening and might be useful to identify subgroups of patients who may benefit most from pharmacological reperfusion.

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