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

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

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 INFORMATION: The online version contains supplementary material available at 10.1007/s00415-021-10497-7.