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Updated: Dec 21, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Has COVID-19 played an unexpected "stroke" on the chain of survival?
Marcello Naccarato1, Ilario Scali1, Sasha Olivo1
1Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy.
Insights
The COVID-19 pandemic reduced stroke admissions by 45%, increasing severe strokes and unknown onset times. Despite effective management strategies, public awareness is crucial for timely stroke symptom reporting.
Area of Science:
- Neurology
- Public Health
- Emergency Medicine
Background:
- COVID-19 pandemic necessitated changes in stroke care protocols.
- The study evaluates the impact of Italy's first lockdown month on stroke management.
- Focuses on a University Hub Stroke Unit in the Italy-Slovenia border region.
Purpose of the Study:
- To assess the effects of the COVID-19 pandemic on stroke management during Italy's initial lockdown.
- To describe the emergency stroke pathway implemented during this period.
Main Methods:
- Comparative analysis of stroke patients admitted during the first lockdown month (March 9-April 9, 2020) versus the same period in 2019.
- Evaluation of clinical features, outcomes, and treatment times.
Main Results:
- Stroke admissions decreased by 45% during lockdown, with a higher proportion of severe strokes (NIHSS>10).
- A significant increase in stroke cases with unknown symptom onset was observed (50% in 2020 vs. 10% in 2019).
- Worse functional outcomes were noted during lockdown, despite similar reperfusion rates and door-to-treatment times; hospitalization was shorter, and work-ups were less complete.
Conclusions:
- Stroke management strategies during the COVID-19 emergency proved effective.
- Reduced and delayed symptom reporting by the public was a significant issue.
- Public awareness campaigns emphasizing rapid recognition of stroke symptoms (F.A.S.T.) are recommended to combat the tendency to delay seeking care.
Background:
The COVID-19 pandemics required several changes in stroke management and it may have influenced some clinical or functional characteristics. We aimed to evaluate the effects of the COVID-19 pandemics on stroke management during the first month of Italy lockdown. In addition, we described the emergency structured pathway adopted by an Italian University Hub Stroke Unit in the cross-border Italy-Slovenia area.
Methods:
We analyzed admitted patients' clinical features and outcomes between 9th March 2020 and 9th April 2020 (first month of lockdown), and compared them with patients admitted during the same period in 2019.
Results:
Total admissions experienced a reduction of 45% during the lockdown compared to the same period in 2019 (16 vs 29, respectively), as well as a higher prevalence of severe stroke (NIHSS>10) at admission (n = 8, 50% vs n = 8, 28%). A dramatic prevalence of stroke of unknown symptom onset was observed in 2020 (n = 8, 50% vs n = 3, 10%). During lockdown, worse functional and independence outcomes were found, despite the similar proportion of reperfused patients. Similar 'symptoms alert-to-admission' and 'door-to-treatment' times were observed. During lockdown hospitalization was shorter and fewer patients completed the stroke work-up.
Conclusion:
In conclusion, the adopted strategies for stroke management during the COVID-19 emergency have suggested being effective, while suffering a reduced and delayed reporting of symptoms. Therefore, we recommend raising awareness among the population against possible stroke symptoms onset. Thus, think F.A.S.T. and do not stay-at-home at all costs.
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