Impact of SARS-CoV-2 on reperfusion therapies for acute ischemic stroke in Lombardy, Italy: the STROKOVID network.

Autor: Pezzini A; Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy. ale_pezzini@hotmail.com., Grassi M; Department of Brain and Behavioural Sciences, Statistics and Genomic Unit, University of Pavia, Pavia, Italy., Silvestrelli G; Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantua, Italy., Locatelli M; Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.; Neurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy., Rifino N; Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy.; Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy., Beretta S; Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy.; Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy., Gamba M; Vascular Neurology, Stroke Unit, Spedali Civili Hospital, ASST Spedali Civili, Brescia, Italy., Raimondi E; Neurology Unit, Ospedale Nuovo, ASST Ovest Milanese, Legnano, Italy., Giussani G; Neurology Unit and Stroke Unit, Department of Neurosciences and Niguarda Neuro Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Carimati F; Neurology Unit, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy., Sangalli D; Neurology Unit, Ospedale 'A. Manzoni', ASST Lecco, Lecco, Italy., Corato M; Emergency Neurology and Stroke Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy., Gerevini S; Department of Neuroradiology, Papa Giovanni XXIII Hospital, ASST Papa Giovanni XXIII, Bergamo, Italy., Masciocchi S; Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy., Cortinovis M; Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy., La Gioia S; Department of Neurology, Papa Giovanni XXIII Hospital, ASST Papa Giovanni XXIII, Bergamo, Italy., Barbieri F; Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantua, Italy., Mazzoleni V; Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy., Pezzini D; Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy., Bonacina S; Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy., Pilotto A; Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy., Benussi A; Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy., Magoni M; Vascular Neurology, Stroke Unit, Spedali Civili Hospital, ASST Spedali Civili, Brescia, Italy., Premi E; Vascular Neurology, Stroke Unit, Spedali Civili Hospital, ASST Spedali Civili, Brescia, Italy., Prelle AC; Neurology Unit, Ospedale Nuovo, ASST Ovest Milanese, Legnano, Italy., Agostoni EC; Neurology Unit and Stroke Unit, Department of Neurosciences and Niguarda Neuro Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy., Palluzzi F; Department of Brain and Behavioural Sciences, Statistics and Genomic Unit, University of Pavia, Pavia, Italy., De Giuli V; Neurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy., Magherini A; Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantua, Italy., Roccatagliata DV; Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantua, Italy., Vinciguerra L; Neurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy., Puglisi V; Neurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy., Fusi L; Neurology Unit, Ospedale 'Sant'Anna', ASST Lariana, Como, Italy., Xhani R; Neurology Unit, Ospedale 'Sant'Anna', ASST Lariana, Como, Italy., Pozzi F; Neurology Unit, Ospedale 'Sant'Anna', ASST Lariana, Como, Italy., Diamanti S; Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy.; Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy., Santangelo F; Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy.; Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy., Grampa G; Neurology Unit, Ospedale 'Sant'Anna', ASST Lariana, Como, Italy., Versino M; Neurology Unit, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy., Salmaggi A; Neurology Unit, Ospedale 'A. Manzoni', ASST Lecco, Lecco, Italy., Marcheselli S; Emergency Neurology and Stroke Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy., Cavallini A; Stroke Unit, IRCCS Fondazione 'C. Mondino', Pavia, Italy., Giossi A; Neurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy., Censori B; Neurology Unit, Istituti Ospitalieri, ASST Cremona, Cremona, Italy., Ferrarese C; Department of Neurology, Ospedale San Gerardo, ASST Monza, Monza, Italy.; Department of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy., Ciccone A; Department of Neurology and Stroke Unit, Carlo Poma Hospital, ASST Mantova, Mantua, Italy., Sessa M; Department of Neurology, Papa Giovanni XXIII Hospital, ASST Papa Giovanni XXIII, Bergamo, Italy., Padovani A; Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2021 Oct; Vol. 268 (10), pp. 3561-3568. Date of Electronic Publication: 2021 Mar 08.
DOI: 10.1007/s00415-021-10497-7
Abstrakt: Whether and how SARS-CoV-2 outbreak affected in-hospital acute stroke care system is still matter of debate. In the setting of the STROKOVID network, a collaborative project between the ten centers designed as hubs for the treatment of acute stroke during SARS-CoV-2 outbreak in Lombardy, Italy, we retrospectively compared clinical features and process measures of patients with confirmed infection (COVID-19) and non-infected patients (non-COVID-19) who underwent reperfusion therapies for acute ischemic stroke. Between March 8 and April 30, 2020, 296 consecutive patients [median age, 74 years (interquartile range (IQR), 62-80.75); males, 154 (52.0%); 34 (11.5%) COVID-19] qualified for the analysis. Time from symptoms onset to treatment was longer in the COVID-19 group [230 (IQR 200.5-270) minutes vs. 190 (IQR 150-245) minutes; p = 0.007], especially in the first half of the study period. Patients with COVID-19 who underwent endovascular thrombectomy had more frequently absent collaterals or collaterals filling ≤ 50% of the occluded territory (50.0% vs. 16.6%; OR 5.05; 95% CI 1.82-13.80) and a lower rate of good/complete recanalization of the primary arterial occlusive lesion (55.6% vs. 81.0%; OR 0.29; 95% CI 0.10-0.80). Post-procedural intracranial hemorrhages were more frequent (35.3% vs. 19.5%; OR 2.24; 95% CI 1.04-4.83) and outcome was worse among COVID-19 patients (in-hospital death, 38.2% vs. 8.8%; OR 6.43; 95% CI 2.85-14.50). Our findings showed longer delays in the intra-hospital management of acute ischemic stroke in COVID-19 patients, especially in the early phase of the outbreak, that likely impacted patients outcome and should be the target of future interventions.
(© 2021. Springer-Verlag GmbH, DE part of Springer Nature.)
Databáze: MEDLINE
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