Acute stroke management during the COVID19 pandemic in Liguria (Italy)

Background and Aims: The aim of this study is to investigate the impact of COVID19 outbreak on ischemic stroke management analyzing the hospitalization rate and treatments performed during the first wave of SARS-CoV-2 spreading in Liguria district (Italy). Methods: All the Neurology Units in Liguria were involved in an observational multicenter study. Data about hospital admissions for ischemic stroke from March 10 to May 18, 2020 (study period), and from March 10 to May 18, 2018 (control period) were analyzed. Results: In 2020, admissions for ischemic stroke within 24 hours from symptoms onset were significantly decreased (451 patients in the control period versus 248 in the study period). In the study period, we observed a significant increase of the onset-to-door time (mean 267, 9±249, 43 versus 232.2±290, 46 minutes, p<0, 001) and a higher mean NIHSS on arrival (8.1 versus 6.9, p<0, 016). The number of intravenous (iv) thrombolysis (38 vs 324, p<0, 001) performed in 2020 was reduced;on the contrary, an increase of intraarterial thrombectomies (21 vs 7, p<0, 001) was observed. Conclusions: During the first Italian lockdown, mainly patients with more severe clinical presentation accessed to hospitals. This finding suggests that both social isolation and fear of being infected by SARS-CoV-2 played a crucial role in preventing patients with milder symptoms to go to emergency rooms. Due to the decrease of hospital admissions and the increase of onset-to-door time, the number of iv thrombolysis performed was subsequently reduced. On the other hand, the number of mechanical thrombectomy was increased, as a result of the increase of patients not suitable for iv treatment and shift toward mothership model of organization.