Delays in thrombolysis during COVID-19 are associated with worse neurological outcomes: the Society of Vascular and Interventional Neurology Multicenter Collaboration

Jillella, Dinesh; Nahab, Fadi; Nguyen, Thanh N.; Abdalkader, Mohamad; Liebeskind, David S; Vora, Nirav; Rai, Vivek; Haussen, Diogo C; Nogueira, Raul G; Desai, Shashvat M; Jadhav, Ashutosh P.; Czap, Alexandra L; Zha, Alicia; Linfante, Italo; Hassan, Ameer E; Quispe‐Orozco, Darko; Ortega‐Gutiérrez, Santiago; Khandelwal, Priyank; Patel, Pratit; Zaidat, Osama O.; Jovin, Tudor G; Kamen, Scott; Siegler, James E.

doi:10.1007/s00415-021-10734-z

Cited by 14 publications

(10 citation statements)

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“…Of note, door to needle time was significantly longer during the COVID pandemic which was also observed in another multicenter study [ 17 ]. The same observation was previously attributed to in-hospital implementation of new protocols for patient triage due to the pandemic [ 18 ].…”

Section: Discussionsupporting

confidence: 76%

Did COVID-19 impact stroke services? A multicenter study

et al. 2022

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Background It has been reported that acute stroke services were compromised during COVID-19 due to various pandemic-related issues. We aimed to investigate these changes by recruiting centers from different countries. Methods Eight countries participated in this cross-sectional, observational, retrospective study by providing data from their stroke data base. We compared 1 year before to 1 year during COVID-19 as regards onset to door (OTD), door to needle (DTN), door to groin (DTG), duration of hospital stay, National Institute of Health Stroke Scale (NIHSS) at baseline, 24 h, and at discharge as well as modified Rankin score (mRS) on discharge and at 3 months follow-up. Results During the pandemic year, there was a reduction in the number of patients, median age was significantly lower, admission NIHSS was higher, hemorrhagic stroke increased, and OTD and DTG showed no difference, while DTN time was longer, rtPA administration was decreased, thrombectomy was more frequent, and hospital stay was shorter. mRS was less favorable on discharge and at 3 months. Conclusion COVID-19 showed variable effects on stroke services. Some were negatively impacted as the number of patients presenting to hospitals, DTN time, and stroke outcome, while others were marginally affected as the type of management.

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Section: Discussionsupporting

confidence: 76%

Did COVID-19 impact stroke services? A multicenter study

et al. 2022

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“…[4][5][6][7][8] As a result of the early surge in COVID-19 admissions, the allocation of health care resources and the delivery of stroke care have been affected. [9][10][11][12][13] During the first wave of the COVID-19 pandemic in 2020, declines in stroke admission volumes, IV thrombolysis (IVT), and mechanical thrombectomy have been reported across regional, [14][15][16][17] national, [18][19][20][21][22][23] and global 6,[24][25][26][27][28][29] studies. In our initial report covering the first 4 months of the COVID-19 pandemic, we observed a greater than 10% decrease in global stroke admissions, IVT treatments, and IVT transfers, followed by recovery of stroke volume in later months.…”

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confidence: 99%

Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events

Nguyen

Qureshi²,

Klein³

et al. 2023

Neurology

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Background and Objectives:Declines in stroke admission, intravenous thrombolysis, and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the impact of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), intravenous thrombolysis (IVT), and mechanical thrombectomy over a one-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020).Methods:We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, intravenous thrombolysis treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.Results:There were 148,895 stroke admissions in the one-year immediately before compared to 138,453 admissions during the one-year pandemic, representing a 7% decline (95% confidence interval [95% CI 7.1, 6.9]; p<0.0001). ICH volumes declined from 29,585 to 28,156 (4.8%, [5.1, 4.6]; p<0.0001) and IVT volume from 24,584 to 23,077 (6.1%, [6.4, 5.8]; p<0.0001). Larger declines were observed at high volume compared to low volume centers (all p<0.0001). There was no significant change in mechanical thrombectomy volumes (0.7%, [0.6,0.9]; p=0.49). Stroke was diagnosed in 1.3% [1.31,1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82,2.97], 5,656/195,539) of all stroke hospitalizations.Discussion:There was a global decline and shift to lower volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared to the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.Trial Registration Information:This study is registered underNCT04934020.

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“…Therefore, future research concentrating on imaging flow may be crucial to achieving a reduction in treatment delays in the ongoing pandemic. The findings of the current investigation ( 26 ) indicate that the prolongation of DTN time and DTP time can have a negative impact on short-term outcomes.…”

Section: Discussionmentioning

confidence: 70%

The impact of COVID-19 pandemic on treatment delay and short-term neurological functional prognosis for acute ischemic stroke during the lockdown period

Shen

et al. 2022

Front. Neurol.

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BackgroundPreventive strategies implemented during the COVID-19 pandemic may negatively influence the management of patients with acute ischemic stroke (AIS). Nowadays, studies have demonstrated that the pandemic has led to a delay in treatment among patients with AIS. Whether this delay contributes to meaningful short-term outcome differences warranted further exploration.ObjectiveThe objective of this study was to evaluate the impacts of the COVID-19 pandemic on treatment delay and short-term outcomes of patients with AIS treated with IVT and MT.MethodsPatients admitted before (from 11/1/2019 to 1/31/2020) and during the COVID-19 pandemic (from 2/1/2020 to 3/31/2020) were screened for collecting sociodemographic data, medical history information, and symptom onset status, and comparing the effect of treatment delay. The patients treated with IVT or MT were compared for delay time and neurological outcomes. Multivariable logistic regression was used to estimate the effect of treatment delay on short-term neurological prognosis.ResultsIn this study, 358 patients receiving IVT were included. DTN time increased from 50 min (IQR 40–75) before to 65 min (IQR 48–84), p = 0.048. 266 patients receiving MT were included. The DTP was 120 (112–148) min vs. 160 (125-199) min before and during the pandemic, p = 0.002. Patients with stroke during the pandemic had delays in treatment due to the need for additional PPE (p < 0.001), COVID-19 screening processes (p < 0.001), multidisciplinary consultation (p < 0.001), and chest CT scans (p < 0.001). Compared with pre-COVID-19, during the pandemic, patients had a higher likelihood of spontaneous intracranial hemorrhage after IVT (OR: 1.10; 95% CI, 1.03–1.30) and a lower likelihood of mRS scores 0–2 at discharge (OR: 0.90; 95% CI, 0.78–0.99). In logistic regression analysis, high NIHSS score at admission, increasing age, worse pre-admission mRS, large vessel occlusion, admission during the lockdown period, and low mTICI grade after MT were associated with an mRS ≥ 3.ConclusionThe COVID-19 pandemic has had remarkable impacts on the management of AIS. The pandemic might exacerbate certain time delays and play a significant role in early adverse outcomes in patients with AIS.

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Delays in thrombolysis during COVID-19 are associated with worse neurological outcomes: the Society of Vascular and Interventional Neurology Multicenter Collaboration

Cited by 14 publications

References 14 publications

Did COVID-19 impact stroke services? A multicenter study

Did COVID-19 impact stroke services? A multicenter study

Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events

The impact of COVID-19 pandemic on treatment delay and short-term neurological functional prognosis for acute ischemic stroke during the lockdown period

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