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Updated: Dec 5, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Reduced Admissions for Cerebrovascular Events During COVID-19 Outbreak in Italy
Simona Sacco1, Stefano Ricci2, Raffaele Ornello1
1Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy (S.S., R.O.).
Insights
Hospital admissions for stroke and transient ischemic attacks significantly decreased in Italy during the COVID-19 outbreak. Revascularization treatments saw a decline in intravenous thrombolysis but an increase in endovascular procedures.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic has impacted healthcare systems globally.
- Understanding its effect on cerebrovascular event management is crucial.
Purpose of the Study:
- To investigate the rate of hospital admissions for cerebrovascular events in Italy during the COVID-19 outbreak.
- To assess changes in revascularization treatments for acute ischemic stroke.
Main Methods:
- A multicenter study involving 93 Italian Stroke Units.
- Collected data on cerebrovascular event hospital admissions from March 2019 to March 2020.
- Compared admission rates and treatment data between the control and study periods.
Main Results:
- Hospitalizations for ischemic stroke, intracerebral hemorrhage, and transient ischemic attacks decreased significantly.
- Intravenous thrombolysis rates declined, while primary endovascular procedures increased in Northern Italy.
- No correlation was found between stroke hospitalization rates and COVID-19 incidence by area.
Conclusions:
- Cerebrovascular event hospitalizations and intravenous thrombolytic treatments reduced during the COVID-19 outbreak.
- Endovascular treatments remained stable or increased, particularly in outbreak epicenters.
- Potential explanations include reduced admissions of less severe cases and emergency system strain due to COVID-19.
Background And Purpose:
We aimed to investigate the rate of hospital admissions for cerebrovascular events and of revascularization treatments for acute ischemic stroke in Italy during the coronavirus disease 2019 (COVID-19) outbreak.
Methods:
The Italian Stroke Organization performed a multicenter study involving 93 Italian Stroke Units. We collected information on hospital admissions for cerebrovascular events from March 1 to March 31, 2020 (study period), and from March 1 to March 31, 2019 (control period).
Results:
Ischemic strokes decreased from 2399 in 2019 to 1810 in 2020, with a corresponding hospitalization rate ratio (RR) of 0.75 ([95% CI, 0.71-0.80] P<0.001); intracerebral hemorrhages decreased from 400 to 322 (hospitalization RR, 0.81 [95% CI, 0.69-0.93]; P=0.004), and transient ischemic attacks decreased from 322 to 196 (hospitalization RR, 0.61 [95% CI, 0.51-0.73]; P<0.001). Hospitalizations decreased in Northern, Central, and Southern Italy. Intravenous thrombolyses decreased from 531 (22.1%) in 2019 to 345 in 2020 (19.1%; RR, 0.86 [95% CI, 0.75-0.99]; P=0.032), while primary endovascular procedures increased in Northern Italy (RR, 1.61 [95% CI, 1.13-2.32]; P=0.008). We found no correlation (P=0.517) between the hospitalization RRs for all strokes or transient ischemic attack and COVID-19 incidence in the different areas.
Conclusions:
Hospitalizations for stroke or transient ischemic attacks across Italy were reduced during the worst period of the COVID-19 outbreak. Intravenous thrombolytic treatments also decreased, while endovascular treatments remained unchanged and even increased in the area of maximum expression of the outbreak. Limited hospitalization of the less severe patients and delays in hospital admission, due to overcharge of the emergency system by COVID-19 patients, may explain these data.
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