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Updated: Dec 13, 2025
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
12.4K
In-Hospital Delays for Acute Stroke Treatment Delivery During the COVID-19 Pandemic
Aristeidis H Katsanos1,2, Danielle de Sa Boasquevisque1,2, Mustafa Ahmed Al-Qarni1,2
1Division of Neurology, Hamilton General Hospital-Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Summary
COVID-19 restrictions significantly delayed stroke treatment times, increasing door-to-CT and door-to-needle times for acute ischemic stroke patients receiving tPA and EVT. Delays were noted from hospital arrival to CT imaging and tPA administration.
Area of Science:
- Neurology
- Public Health
- Emergency Medicine
Background:
- The COVID-19 pandemic led to widespread social and healthcare restrictions.
- These restrictions may have impacted the timely management of acute ischemic stroke.
- Understanding these impacts is crucial for optimizing stroke care during public health crises.
Purpose of the Study:
- To investigate the effect of COVID-19-related restrictions on time metrics for acute ischemic stroke management.
- To compare treatment times before and after the implementation of regional restrictions in Central South Ontario, Canada.
Main Methods:
- Retrospective analysis of acute ischemic stroke patients treated with intravenous thrombolysis (tPA) and/or endovascular thrombectomy (EVT).
- Comparison of key time metrics (door-to-CT, door-to-needle) before and after March 17, 2020 (declaration of restrictions).
Main Results:
- Significant increases observed in median door-to-CT times for both tPA and EVT patients post-restrictions.
- Median door-to-needle time significantly increased for tPA recipients.
- No delays were found in symptom onset to hospital presentation for either treatment group.
Conclusions:
- COVID-19 restrictions led to increased institutional delays in acute ischemic stroke treatment.
- Delays primarily occurred between hospital presentation and CT imaging acquisition, and in tPA administration.
- Stroke centers must develop strategies to mitigate treatment delays during public health emergencies.
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