Abstract
Whether and how SARS-CoV-2 outbreak affected in-hospital acute stroke care system is still matter of debate. In the setting of the STROKOVID network, a collaborative project between the ten centers designed as hubs for the treatment of acute stroke during SARS-CoV-2 outbreak in Lombardy, Italy, we retrospectively compared clinical features and process measures of patients with confirmed infection (COVID-19) and non-infected patients (non-COVID-19) who underwent reperfusion therapies for acute ischemic stroke. Between March 8 and April 30, 2020, 296 consecutive patients [median age, 74 years (interquartile range (IQR), 62–80.75); males, 154 (52.0%); 34 (11.5%) COVID-19] qualified for the analysis. Time from symptoms onset to treatment was longer in the COVID-19 group [230 (IQR 200.5–270) minutes vs. 190 (IQR 150–245) minutes; p = 0.007], especially in the first half of the study period. Patients with COVID-19 who underwent endovascular thrombectomy had more frequently absent collaterals or collaterals filling ≤ 50% of the occluded territory (50.0% vs. 16.6%; OR 5.05; 95% CI 1.82–13.80) and a lower rate of good/complete recanalization of the primary arterial occlusive lesion (55.6% vs. 81.0%; OR 0.29; 95% CI 0.10–0.80). Post-procedural intracranial hemorrhages were more frequent (35.3% vs. 19.5%; OR 2.24; 95% CI 1.04–4.83) and outcome was worse among COVID-19 patients (in-hospital death, 38.2% vs. 8.8%; OR 6.43; 95% CI 2.85–14.50). Our findings showed longer delays in the intra-hospital management of acute ischemic stroke in COVID-19 patients, especially in the early phase of the outbreak, that likely impacted patients outcome and should be the target of future interventions. Supplementary InformationThe online version contains supplementary material available at 10.1007/s00415-021-10497-7.
Highlights
With more than 17,600 deaths out of a population of approximately 10 million inhabitants [1], the Lombardy region, located in Northern Italy, is one of the areas most severely hit by SARS-CoV-2 since the very beginning of the Extended author information available on the last page of the article pandemic
Since these ten centers were designated hospitals for transfer of patients from the contiguous catchment area at the early stage of the outbreak, this implicates that all patients with suspected or proven acute stroke—regardless of whether they were eligible for acute reperfusion therapy—were transferred from the spokes to the ten hubs, which, became in charge of the management of all acute strokes in the Lombardy region during the study period
The STROKOVID network is a joint initiative of these ten hub centers, which is expected to provide comprehensive information on patients hospitalized for acute ischemic stroke in Lombardy during SARS-CoV-2 outbreak and to address clinical research questions
Summary
With more than 17,600 deaths out of a population of approximately 10 million inhabitants [1], the Lombardy region, located in Northern Italy, is one of the areas most severely hit by SARS-CoV-2 since the very beginning of the Extended author information available on the last page of the article pandemic. Specific measures have been taken to contain the spread of the disease, including locking down the communities, converting general medical wards to quarantine wards, and reorganizing in-hospital clinical activities with plans for the emergency management and treatment of acute conditions. One such measure has been to concentrate a large majority of acute stroke patients in a limited number of hospitals [2]. Whether this had an influence on timely reperfusion strategies for acute brain ischemia is currently unknown.
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