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

• DOI: 10.1007/s00415-021-10497-7
• Publication Date: 2021-03-08T07:03:11Z
• Authors: Alessandro Pezzini; Mario Grassi; Giorgio Silvestrelli; Martina Locatelli; Nicola Rifino; Simone Beretta; Massimo Gamba; Elisa Raimondi; Giuditta Giussani; Federico Carimati; Davide Sangalli; Manuel Corato; Simonetta Gerevini; Stefano Masciocchi; Matteo Cortinovis; Sara La Gioia; Francesca Barbieri; Valentina Mazzoleni; Debora Pezzini; Sonia Bonacina; Andrea Pilotto; Alberto Benussi; Mauro Magoni; Enrico Premi; Alessandro Cesare...; Elio Clemente Ago...; Fernando Palluzzi; Valeria De Giuli; Anna Magherini; Daria Valeria Roc...; Luisa Vinciguerra; Valentina Puglisi; Laura Fusi; Rubjona Xhani; Federico Pozzi; Susanna Diamanti; Francesco Santangelo; Giampiero Grampa; Maurizio Versino; Andrea Salmaggi; Simona Marcheselli; Anna Cavallini; Alessia Giossi; Bruno Censori; Carlo Ferrarese; Alfonso Ciccone; Maria Sessa; Alessandro Padovani
• Keywords: Interquartile range; Stroke; Neuroradiology; Acute stroke

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 10 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 [interquartile range (IQR), 62–80.75] years; 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.