Impact of SARS-CoV-2 on reperfusion therapies for acute ischemic stroke in Lombardy, Italy: the STROKOVID network

• Published in: Journal of neurology Vol. 268; no. 10; pp. 3561 - 3568
• Main Authors: Pezzini, Alessandro, Grassi, Mario, Silvestrelli, Giorgio, Locatelli, Martina, Rifino, Nicola, Beretta, Simone, Gamba, Massimo, Raimondi, Elisa, Giussani, Giuditta, Carimati, Federico, Sangalli, Davide, Corato, Manuel, Gerevini, Simonetta, Masciocchi, Stefano, Cortinovis, Matteo, La Gioia, Sara, Barbieri, Francesca, Mazzoleni, Valentina, Pezzini, Debora, Bonacina, Sonia, Pilotto, Andrea, Benussi, Alberto, Magoni, Mauro, Premi, Enrico, Prelle, Alessandro Cesare, Agostoni, Elio Clemente, Palluzzi, Fernando, De Giuli, Valeria, Magherini, Anna, Roccatagliata, Daria Valeria, Vinciguerra, Luisa, Puglisi, Valentina, Fusi, Laura, Xhani, Rubjona, Pozzi, Federico, Diamanti, Susanna, Santangelo, Francesco, Grampa, Giampiero, Versino, Maurizio, Salmaggi, Andrea, Marcheselli, Simona, Cavallini, Anna, Giossi, Alessia, Censori, Bruno, Ferrarese, Carlo, Ciccone, Alfonso, Sessa, Maria, Padovani, Alessandro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2021; Springer Nature B.V
• Subjects: Cardiovascular system; Coronaviruses; COVID-19; Ischemia; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosciences; Original Communication; Outbreaks; Patients; Reperfusion; Severe acute respiratory syndrome coronavirus 2; Stroke; Italy; Lombardy Italy; Stroke; Coronavirus disease; Public health
• ISSN: 0340-5354; 1432-1459; 1432-1459
• DOI: 10.1007/s00415-021-10497-7

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.