Giovanni Furlanis1, Miloš Ajčević2, Ilario Scali1, Alex Buoite Stella1, Sasha Olivo1, Carlo Lugnan1, Paola Caruso1, Roberta Antea Pozzi Mucelli3, Agostino Accardo4, Maria Assunta Cova3, Marcello Naccarato1, Paolo Manganotti1. 1. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy. 2. Department of Engineering and Architecture, University of Trieste, Via A. Valerio, 10, 34127, Trieste, Italy. majcevic@units.it. 3. Radiology Unit, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy. 4. Department of Engineering and Architecture, University of Trieste, Via A. Valerio, 10, 34127, Trieste, Italy.
Abstract
PURPOSE: The fear of COVID-19 infection may discourage patients from going to the hospital even in case of sudden onset of disabling symptoms. There is growing evidence of the reduction of stroke admissions and higher prevalence of severe clinical presentation. Yet, no studies have investigated the perfusion pattern of acute strokes admitted during the lockdown. We aimed to evaluate the effects of the COVID-19 pandemic on hyper-acute stroke CT perfusion (CTP) pattern during the first months of the pandemic in Italy. METHODS: In this retrospective observational study, we analyzed CTP images and clinical data of ischemic stroke patients admitted between 9 March and 2 June 2020 that underwent CTP (n = 30), to compare ischemic volumes and clinical features with stroke patients admitted during the same period in 2019 (n = 51). In particular, CTP images were processed to calculate total hypoperfused volumes, core volumes, and mismatch. The final infarct volumes were calculated on follow-up CT. RESULTS: Significantly higher total CTP hypoperfused volume (83.3 vs 18.5 ml, p = 0.003), core volume (27.8 vs 1.0 ml, p < 0.001), and unfavorable mismatch (0.51 vs 0.91, p < 0.001) were found during the COVID-19 period compared to no-COVID-19 one. The more unfavorable perfusion pattern at admission resulted in higher infarct volume on follow-up CT during COVID-19 (35.5 vs 3.0 ml, p < 0.001). During lockdown, a reduction of stroke admissions (- 37%) and a higher prevalence of severe clinical presentation (NIHSS ≥ 10; 53% vs 36%, p = 0.029) were observed. CONCLUSION: The results of CTP analysis provided a better insight in the higher prevalence of major severity stroke patients during the COVID-19 period.
PURPOSE: The fear of COVID-19 infection may discourage patients from going to the hospital even in case of sudden onset of disabling symptoms. There is growing evidence of the reduction of stroke admissions and higher prevalence of severe clinical presentation. Yet, no studies have investigated the perfusion pattern of acute strokes admitted during the lockdown. We aimed to evaluate the effects of the COVID-19 pandemic on hyper-acute stroke CT perfusion (CTP) pattern during the first months of the pandemic in Italy. METHODS: In this retrospective observational study, we analyzed CTP images and clinical data of ischemic stroke patients admitted between 9 March and 2 June 2020 that underwent CTP (n = 30), to compare ischemic volumes and clinical features with stroke patients admitted during the same period in 2019 (n = 51). In particular, CTP images were processed to calculate total hypoperfused volumes, core volumes, and mismatch. The final infarct volumes were calculated on follow-up CT. RESULTS: Significantly higher total CTP hypoperfused volume (83.3 vs 18.5 ml, p = 0.003), core volume (27.8 vs 1.0 ml, p < 0.001), and unfavorable mismatch (0.51 vs 0.91, p < 0.001) were found during the COVID-19 period compared to no-COVID-19 one. The more unfavorable perfusion pattern at admission resulted in higher infarct volume on follow-up CT during COVID-19 (35.5 vs 3.0 ml, p < 0.001). During lockdown, a reduction of stroke admissions (- 37%) and a higher prevalence of severe clinical presentation (NIHSS ≥ 10; 53% vs 36%, p = 0.029) were observed. CONCLUSION: The results of CTP analysis provided a better insight in the higher prevalence of major severity stroke patients during the COVID-19 period.
Authors: Matthew D Solomon; Edward J McNulty; Jamal S Rana; Thomas K Leong; Catherine Lee; Sue-Hee Sung; Andrew P Ambrosy; Stephen Sidney; Alan S Go Journal: N Engl J Med Date: 2020-05-19 Impact factor: 91.245
Authors: Antonio Granato; Laura D'Acunto; Miloš Ajčević; Giovanni Furlanis; Maja Ukmar; Roberta Antea Pozzi Mucelli; Paolo Manganotti Journal: Neurol Sci Date: 2020-05-26 Impact factor: 3.307
Authors: Henry Ma; Bruce C V Campbell; Mark W Parsons; Leonid Churilov; Christopher R Levi; Chung Hsu; Timothy J Kleinig; Tissa Wijeratne; Sami Curtze; Helen M Dewey; Ferdinand Miteff; Chon-Haw Tsai; Jiunn-Tay Lee; Thanh G Phan; Neil Mahant; Mu-Chien Sun; Martin Krause; Jonathan Sturm; Rohan Grimley; Chih-Hung Chen; Chaur-Jong Hu; Andrew A Wong; Deborah Field; Yu Sun; P Alan Barber; Arman Sabet; Jim Jannes; Jiann-Shing Jeng; Benjamin Clissold; Romesh Markus; Ching-Huang Lin; Li-Ming Lien; Christopher F Bladin; Søren Christensen; Nawaf Yassi; Gagan Sharma; Andrew Bivard; Patricia M Desmond; Bernard Yan; Peter J Mitchell; Vincent Thijs; Leeanne Carey; Atte Meretoja; Stephen M Davis; Geoffrey A Donnan Journal: N Engl J Med Date: 2019-05-09 Impact factor: 91.245
Authors: Götz Thomalla; Claus Z Simonsen; Florent Boutitie; Grethe Andersen; Yves Berthezene; Bastian Cheng; Bharath Cheripelli; Tae-Hee Cho; Franz Fazekas; Jens Fiehler; Ian Ford; Ivana Galinovic; Susanne Gellissen; Amir Golsari; Johannes Gregori; Matthias Günther; Jorge Guibernau; Karl Georg Häusler; Michael Hennerici; André Kemmling; Jacob Marstrand; Boris Modrau; Lars Neeb; Natalia Perez de la Ossa; Josep Puig; Peter Ringleb; Pascal Roy; Enno Scheel; Wouter Schonewille; Joaquin Serena; Stefan Sunaert; Kersten Villringer; Anke Wouters; Vincent Thijs; Martin Ebinger; Matthias Endres; Jochen B Fiebach; Robin Lemmens; Keith W Muir; Norbert Nighoghossian; Salvador Pedraza; Christian Gerloff Journal: N Engl J Med Date: 2018-05-16 Impact factor: 91.245
Authors: Hassan Bagher-Ebadian; Kourosh Jafari-Khouzani; Panayiotis D Mitsias; Mei Lu; Hamid Soltanian-Zadeh; Michael Chopp; James R Ewing Journal: PLoS One Date: 2011-08-10 Impact factor: 3.240