The impact of SARS-CoV-2 infection on the outcome of acute ischemic stroke-A retrospective cohort study.

BACKGROUND: Acute ischemic stroke (AIS) is a common complication of severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) infection (COVID-19), but the prognosis of these patients is poorly understood. PURPOSE: To explore the impact of COVID-19 on neurological outcomes 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 showed tendency to worse initial neurological deficit (NIHSS 9 (3-13) vs. 4 (2-10); p = 0.06), 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.

Improved Stroke Care in a Primary Stroke Centre Using AI-Decision Support.

BACKGROUND: Patient selection for reperfusion therapies requires significant expertise in neuroimaging. Increasingly, machine learning-based analysis is used for faster and standardized patient selection. However, there is little information on how such software influences real-world patient management. AIMS: We evaluated changes in thrombolysis and thrombectomy delivery following implementation of automated analysis at a high volume primary stroke centre. METHODS: We retrospectively collected data on consecutive stroke patients admitted to a large university stroke centre from two identical 7-month periods in 2017 and 2018 between which the e-Stroke Suite (Brainomix, Oxford, UK) was implemented to analyse non-contrast CT and CT angiography results. Delivery of stroke care was otherwise unchanged. Patients were transferred to a hub for thrombectomy. We collected the number of patients receiving intravenous thrombolysis and/or thrombectomy, the time to treatment; and outcome at 90 days for thrombectomy. RESULTS: 399 patients from 2017 and 398 from 2018 were included in the study. From 2017 to 2018, thrombolysis rates increased from 11.5% to 18.1% with a similar trend for thrombectomy (2.8-4.8%). There was a trend towards shorter door-to-needle times (44-42 min) and CT-to-groin puncture times (174-145 min). There was a non-significant trend towards improved outcomes with thrombectomy. Qualitatively, physician feedback suggested that e-Stroke Suite increased decision-making confidence and improved patient flow. CONCLUSIONS: Use of artificial intelligence decision support in a hyperacute stroke pathway facilitates decision-making and can improve rate and time of reperfusion therapies in a hub-and-spoke system of care.

Impact of COVID-19 on ischemic stroke care in Hungary.

Data about the coronavirus disease 2019 (COVID-19) pandemic's collateral damage on ischemic stroke (IS) care during the second epidemic wave in Central Europe are limited. We sought to evaluate the impact of the COVID-19 outbreak on Hungarian IS care during the two epidemic waves. This retrospective observational study was based on a nationwide reimbursement database that encompasses all IS admissions and all reperfusion interventions, i.e., intravenous thrombolysis (IVT) and endovascular therapy (EVT) from 2 January 2017 to 31 December 2020 in Hungary. COVID-19 pandemic's effect on the number of IS admissions and reperfusion interventions were analyzed using different statistics: means, medians, trends, relative rates, and linear relationships. The mean and median values of IS admissions and reperfusion interventions decreased only in some measure during the COVID-periods. However, trend analysis demonstrated a significant decline from the trends. The decline's dynamic and amplitude have differed for each variable. In contrast to IVT, the number of IS admissions and EVTs negatively correlated with the epidemic waves' amplitude. Besides, the decrease in the number of IS admissions was more pronounced than the decrease in the number of reperfusion interventions. Our study demonstrated a significant disruption in IS care during the COVID-19 epidemic in Hungary, in which multiple different factors might play a role. The disproportionate reduction of IS admission numbers could partially be explained by the effect of health emergency operative measures and changes in patients' social behavior. Further studies are needed to evaluate the causes of our observations.

Effects of COVID-19 pandemic on acute ischemic stroke care. A single-centre retrospective analysis of medical collateral damage. / A COVID-19-pandémia hatása az akut ischaemiás stroke ellátásra. A járulékos egészségügyi veszteségek retrospektív, egycentrumos felmérése (A COVID-19-pandémia orvosszakmai kérdései).

INTRODUCTION: Early international observations report decreased number of acute ischemic stroke admissions and prolonged onset-to-treatment times during COVID-19 pandemic. AIM: Our goal was to assess the effect of COVID-19 pandemic on Hungarian acute ischemic stroke care. METHOD: We compared demographical and clinical characteristics, rate of intravenous and endovascular therapies and therapeutic time parameters of acute ischemic strokes admitted to a university stroke centre in a COVID-epidemic period (01/03/2020-30/04/2020) and an identical period of 2019. RESULTS: 86 patients were admitted during the COVID-period and 97 in the control period. Demographical and clinical characteristics of these periods were well-balanced. In the COVID-period, the proportion of patients arriving beyond 24 hours after onset increased by 13% (p = 0.046), the rate of endovascular interventions remained unchanged (8%), the rate of intravenous thrombolysis decreased from 26% to 16%, the mean onset-to-treatment time of thrombolysis increased by 20 minutes, while the mean door-to-treatment time increased by only 5 minutes. Behind the shift of arrival time categories, multivariable (year of examination, NIHSS, age) logistic regression shows that the year of examination might play a leading role (p = 0.096). CONCLUSION: In the COVID-period, admissions for acute ischemic strokes decreased by 11% and the proportion of cases certainly untreatable by reperfusion therapies (arriving beyond 24 hours after onset) increased significantly. While the rate of endovascular interventions remained unchanged, the absolute rate of intravenous thrombolysis decreased by 10% and the mean onset-to-treatment time showed a tendency to increase. In these changes, the COVID-epidemic itself and related out-of-hospital factors might play a leading role. Orv Hetil. 2020; 161(34): 1395-1399.