Effect of lockdown on the management of ischemic stroke: an Italian experience from a COVID hospital

Frisullo, Giovanni; Brunetti, Valerio; Iorio, Riccardo Di; Broccolini, Aldobrando; Caliandro, Pietro; Monforte, Mauro; Morosetti, Roberta; Piano, Carla; Pilato, Fabio; Calabresi, Paolo; Marca, Giacomo Della

doi:10.1007/s10072-020-04545-9

Cited by 42 publications

(71 citation statements)

References 10 publications

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“…However, Schirmer et al and Montaner et al describe a significant increase in stroke onset time to arrival at the hospital during the COVID-19 period for a collaboration of 12 hospitals in 6 states in the USA and Seville in Spain, respectively [ 6 , 10 ]. This is similar to Frisullo et al, who reported a significant increase in the onset-to-door time in the early phase of the pandemic in Rome [ 13 ]. Such differences may reflect different policies in prioritisation of stroke transfer and/or differing strain on existing services due to high numbers of COVID-19 patients.…”

Section: Discussionsupporting

confidence: 89%

Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

et al. 2020

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Introduction The coronavirus disease (COVID-19) pandemic has changed routine clinical practice worldwide with major impacts on the provision of care and treatment for stroke patients. Methods This retrospective observational study included all patients admitted to the Royal Stoke University Hospital in Stoke-on-Trent, UK, with a stroke or transient ischaemic attack between March 15th and April 14th, 2020 (COVID). Patient demographics, characteristics of the stroke, treatment details and logistics were compared with patients admitted in the corresponding weeks in the year before (2019). Results There was a 39.5% (n = 101 vs n = 167) reduction in admissions in the COVID cohort compared with 2019 with more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) 7 vs 4, p = 0.02), and fewer strokes with no visible acute pathology (21.8 vs 37.1%, p = 0.01) on computed tomography. There was no statistically significant difference in the rates of thrombolysis (10.9 vs 13.2%, p = 0.72) and/or thrombectomy (5.9 vs 4.8%, p = 0.90) and no statistically significant difference in time from stroke onset to arrival at hospital (734 vs 576 min, p = 0.34), door-to-needle time for thrombolysis (54 vs 64 min, p = 0.43) and door-to-thrombectomy time (181 vs 445 min, p = 0.72). Thirty-day mortality was not significantly higher in the COVID year (10.9 vs 8.9%, p = 0.77). None of the 7 stroke patients infected with COVID-19 died. Conclusions During the COVID-19 pandemic, the number of stroke admissions fell, and stroke severity increased. There was no statistically significant change in the delivery of thrombolysis and mechanical thrombectomy and no increase in mortality.

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Section: Discussionsupporting

confidence: 89%

Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

et al. 2020

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“…In line with previous studies, the volume of IVT markedly decreased during the COVID-19 period [3][4][5][7][8][9][10]. The main factor for limiting the use of IVT among patients treated with MT was time delay.…”

Section: Discussionsupporting

confidence: 88%

“…The main factor for limiting the use of IVT among patients treated with MT was time delay. The volume of MT remained stable between the two periods while previous studies have reported conflicting results [3][4][5][8][9][10]. The regional variability of the impact of COVID-19 on acute stroke care is illustrated by a German study which found a relevant effect on MT in a only one out of four centers [10].…”

Section: Discussionmentioning

confidence: 94%

“…The effect of the COVID-19 pandemic on stroke care is still debated. Although some studies have reported an impact of the pandemic on acute ischemic stroke (AIS) care in terms of admissions and reperfusion therapy volumes along with longer treatment times and a decrease in the use of stroke imaging compared with control periods in 2019, other reports have not detected significant effects on revascularization procedures [3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network

et al. 2020

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Background The coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period. Methods We conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods. Results A total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period [55 (54.5%) vs 74 (69.2%); p = 0.03]. The volume of MT remains stable over the two periods [72 (71.3%) vs 65 (60.8%); p = 0.14], but the door-to-groin puncture time increased in patients transferred for MT (237 [187-339] vs 210 [163-260]; p < 0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133-2238] vs 1023 [960-1410]; p < 0.01). Conclusions Our study showed a decrease in the volume of IVT, whereas the volume of MT remained stable although intrahospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.

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“…130 Moreover, the availability of acute reperfusion therapies, including both intravenous thrombolysis and mechanical thrombectomy has been limited, according to recent reports from North America and Europe. [71][72][73][74][75] When administered, treatment time metrics are prolonged, negatively impacting the effectiveness of the treatments. 131 The performance of the more time-consuming, multiparametric stroke neuroimaging techniques is reported to have also declined, which, in turn, impedes the recognition of eligible patients for acute reperfusion therapies.…”

Section: Impact Of Covid-19 Pandemic On Stroke Managementmentioning

confidence: 99%

COVID-19 and cerebrovascular diseases: a comprehensive overview

Tsivgoulis

Palaiodimou

Zand

et al. 2020

Ther Adv Neurol Disord

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Neurological manifestations are not uncommon during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A clear association has been reported between cerebrovascular disease and coronavirus disease 2019 (COVID-19). However, whether this association is causal or incidental is still unknown. In this narrative review, we sought to present the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describe the stroke syndromes and their prognosis and discuss several clinical, radiological, and laboratory characteristics that may aid in the prompt recognition of cerebrovascular disease during COVID-19. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune reaction and inflammation, coagulopathy, COVID-19-associated cardiac injury with subsequent cardio-embolism, complications due to critical illness and prolonged hospitalization can all contribute as potential etiopathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral hemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients with a prevalence ranging between 0.5% and 5%. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients in different cohort studies. Specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ to alarm clinicians in recognizing COVID-19-related stroke.

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Effect of lockdown on the management of ischemic stroke: an Italian experience from a COVID hospital

Cited by 42 publications

References 10 publications

Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network

COVID-19 and cerebrovascular diseases: a comprehensive overview

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