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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
The Impact of COVID-19 on the Acute Stroke Care Pathway: Looking Beyond the Short Term
Mengqiu Zhong1, Hanlin Xiong1, Kebiao Zhang1
1Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Insights
The COVID-19 pandemic increased acute ischemic stroke severity and mortality, with longer treatment times. However, reperfusion success was maintained through procedural adjustments, highlighting the need for more resources in stroke care.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted stroke care pathways globally.
- Mid/long-term effects on acute stroke treatment efficiency and effectiveness remain largely unknown.
Purpose of the Study:
- To analyze the impact of the COVID-19 pandemic on the acute stroke care pathway.
- To evaluate treatment efficiency and effectiveness indicators during the pandemic.
Main Methods:
- Retrospective analysis of 1492 acute stroke patients in Chongqing, China.
- Comparison of patient data from the pandemic period (2020) with a similar period in 2019.
- Collection of demographic, clinical characteristics, and outcomes, including National Institutes of Health Stroke Scale (NIHSS) scores and mortality.
Main Results:
- An increase in acute ischemic stroke patients and higher NIHSS scores and mortality were observed during the pandemic.
- Increased median door-CT and emergency stay times were noted.
- Lower rates of intravenous thrombolysis (IVT) and higher rates of mechanical thrombectomy (MET) occurred, with delayed IVT.
Conclusions:
- The COVID-19 pandemic did not deter patients from seeking stroke care.
- Adjustments in stroke procedures maintained reperfusion success despite pandemic challenges.
- Increased investment in acute stroke care pathways is crucial to prevent adverse outcomes from untreated strokes.
Background:
Early in the pandemic, coronavirus disease 2019 (COVID-19) had been reported with significant impact on the stroke care pathway. Meanwhile, the mid/long-term consequence of treatment efficiency and effectiveness of the acute stroke pathway still remains unknown.
Methods:
A comprehensive retrospective analysis was conducted on the acute stroke care pathway parameters in a stroke unit in Chongqing, Southwest China. A total of 1492 patients were involved in this study, of whom 634 patients (42.5%) were included during the COVID-19 pandemic, 858 patients (57.5%) included during the similar period of 2019. We collected demographic and clinical characteristics, clinical outcome as the treatment efficiency and effectiveness indicators of the acute stroke pathway.
Results:
Compared to the same period in 2019, there were 2.8% fewer transient ischemic attack (TIA) patients, while 9.9% more acute ischemic stroke patients in 2020. In addition, patients had significantly higher National Institutes of Health Stroke Scale (NIHSS) scores (P = 0.002) and hospital mortality (P = 0.004) during the pandemic. The median door-CT time (P < 0.001) and emergency stay (P < 0.001) of acute stroke were also remarkably increased during the pandemic. The proportion of patients with intravenous thrombolysis (IVT) was significantly lower (P < 0.001), while the mechanical thrombectomy (MET) was remarkably higher (P = 0.042) in the pandemic group. Moreover, the IVT was significantly delayed during the pandemic (door-needle time: P = 0.001).
Conclusion:
The COVID-19 outbreak did not reduce the willingness of the acute stroke patient to seek medical help. Benefited from adjustments of stroke procedure in response to the COVID-19 pandemic, no significant reduction was observed in the reperfusion success of the acute stroke care pathway. However, more medical resources need to be invested into the acute stroke care pathway to prevent serious consequences of undiagnosed and untreated strokes.
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