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The Impact of COVID-19 on Emergent Large-Vessel Occlusion: Delayed Presentation Confirmed by ASPECTS

D J Altschul1, N Haranhalli2, C Esenwa3

  • 1Department of Neurosurgery (D.J.A., N.H., S.R.U., R.d.L.G.R., J.R.-T., A.T.) daltschu@montefiore.org.

AJNR. American Journal of Neuroradiology
|September 5, 2020
PubMed

Insights

The COVID-19 pandemic delayed acute ischemic stroke patient presentations, reducing eligibility for mechanical thrombectomy. In-hospital care times remained consistent, but fewer patients received critical treatments.

Area of Science:

  • Neurology
  • Public Health
  • Emergency Medicine

Background:

  • The COVID-19 pandemic significantly impacted healthcare systems globally.
  • Acute ischemic stroke (AIS) requires time-sensitive interventions for optimal outcomes.
  • Emergent large-vessel occlusion (ELVO) strokes are a severe subtype of AIS.

Purpose of the Study:

  • To evaluate the effect of the COVID-19 pandemic on the presentation, treatment, and outcomes of patients with ELVO.
  • To test the hypothesis that the pandemic led to delayed patient presentations for AIS.

Main Methods:

  • Retrospective cohort study comparing two groups of ELVO patients from Montefiore Health System (Bronx, NY).
  • Pre-pandemic cohort (Jan 1-Feb 17, 2020) and pandemic cohort (Mar 1-Apr 17, 2020).
  • Data abstracted from electronic health records including demographics, stroke severity scores (ASPECTS, NIHSS), time metrics, treatment details, and outcomes (mRS, mortality).

Main Results:

  • Patients in the pandemic group were younger (66 vs 72 years) and presented with lower ASPECTS scores (7 vs 9).
  • Significantly longer hospital arrival times were observed during the pandemic (361 vs 152 minutes).
  • There was a decreased rate of thrombolysis administration (22% vs 43%) and mechanical thrombectomy (33% vs 61%) during the pandemic.

Conclusions:

  • The COVID-19 pandemic resulted in delayed hospital presentations for patients with ELVO.
  • These delays reduced the number of patients eligible for time-sensitive treatments like mechanical thrombectomy.
  • In-hospital evaluation and treatment times remained unchanged, indicating system efficiency was maintained.
Abstract

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