ABSTRACT
Background: Acute ischemic stroke (AIS) is a frequent complication of coronavirus disease (COVID-19), but the prognosis of these patients is poorly understood. Aim: To explore the impact of COVID-19 on neurological outcome in AIS patients. Methods: A comparative retrospective cohort study was conducted in 32 consecutive AIS patients with and 51 without COVID-19 between the 1st of March 2020 and 1st of May 2021. The evaluation was based on a detailed chart review for demographic data, medical history, stroke severity, cranial and vessel imaging results, laboratory parameters, COVID-19 severity, hospitalization time, in-hospital mortality, and functional deficits at discharge (modified Rankin Scale, mRS). Results: COVID-19 AIS patients had worse initial neurological deficit (NIHSS 9 (3-13) vs. 4 (2-10);p=0.06), showed tendency to higher rate of large vessel occlusion (LVO;13/32 vs. 14/51;p=0.21), had prolonged hospitalization (19.4 ± 17.7 vs. 9.7 ± 7 days;p=0.003), had lower chance of functional independence (mRS≤2) (12/32 vs. 32/51;p=0.02) and showed higher in-hospital mortality (10/32 vs. 6/51;p=0.02). In COVID-19 AIS patients, LVO was more common with COVID-19 pneumonia than without (55.6% vs. 23.1%;p=0.139). Conclusion: COVID-19-related AIS carries a worse prognosis. COVID- 19 with pneumonia seems to be associated with a higher rate of LVO.
ABSTRACT
Background and aims: Our previous study demonstrated a significant disruption in ischemic stroke care during the COVID-19 outbreak in Hungary, with a significant decline in mechanical thrombectomy (MT). We aimed to assess the differences between thrombectomy centres. Methods: In our nationwide retrospective study, we assessed the number of MTs between 2/01/2017-31/12/2020 in Hungary. Thrombectomy centres were categorized as high- or low-volume (weekly median EVT ≥5 or <5) centres, which data then were pooled into high- and lowvolume groups. COVID-19's impact on pooled MT volumes was analyzed during the first two epidemic waves, comparing weekly medians of raw and standardized (z-scores) MT numbers to the identical period of the previous year. Results: Although during the first epidemic wave, the raw MT numbers did not change considerably either in the high- or low-volume groups (10.00 vs 9.00, p=0.875;11.96 vs 12.93, p=1, respectively), the analysis of z-scores showed a significant decline in the low-volume cohort, but not in the high-volume group (-0.19 vs -0.93, p=0.015;0.60 vs -0.47, p=0.057). During the second epidemic wave, raw and standardized MT numbers decreased significantly in the low-volume but not in the high-volume group (raw numbers: 14.93 vs 12.96, p=0.035;8.00 vs 9.00, p=0.836;respectively. z-scores: 0.39 vs -1.69, p<0.001;-0.40 vs -0.74, p=0.243, respectively). Conclusions: Our study demonstrated a remarkable decline in MT numbers in the low-volume but not in the high-volume group of thrombectomy centres. One of the reasons may be the different institutional settings and involvement in the action against COVID-19.