Maurizio Balestrino (Italy)
Università di Genova NeurologyAuthor Of 2 Presentations
SARS-COV-2 PANDEMIC IMPACTED ON STROKE MANAGEMENT: THE EXPERIENCE OF THE STROKE STUDY GROUP IN LIGURIA (ITALY)
- Ilaria Gandoglia (Italy)
Abstract
Background and Aims:
The aim of this report is to investigate the changes in rate of hospitalization and treatment of ischemic stroke during the first wave of COVID19 outbreak in Liguria district, Italy.
Methods:
A multicenter study involving all the Neurology Units in Liguria was carried out to analyze 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).
Results:
During the study period, a significant reduction of hospital accesses for ischemic stroke within 24 hours from symptoms onset was observed (451 cases in the control period versus 248 in the study period). Onset-to-door time was significantly increased in 2020 (mean 267,9±249,43 versus 232.2±290,46 minutes, p<0,001) as well as the mean NIHSS on arrival (8.1 versus 6.9, p<0,016). In the study period, we observed a reduction of the number of intravenous (iv) thrombolysis (38 vs 324, p<0,001) and an increase of intraarterial thrombectomies (21 vs 7, p<0,001).
Conclusions:
Our data support the hypothesis that social isolation and fear of being infected by SARS-CoV-2 played a crucial role in decreasing patients accesses to hospitals during the first Italian lockdown. In this scenario, mainly patients with more severe clinical presentations came 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.
COGNITIVE DECLINE IN LATE-ONSET EPILEPSY OF UNDEFINED ETIOLOGY: A LONGITUDINAL COHORT STUDY
- Michele Romoli (Italy)
Abstract
Background and Aims:
Symptomatic intraparenchymal hemorrhage (sICH) and major bleeding can be fatal complications of intravenous thrombolysis (IVT) for acute ischemic stroke. We investigated the impact of early fibrinogen depletion after IVT on major bleeding events.
Methods:
This multicenter observational study enrolled consecutive patients receiving IVT for acute ischemic stroke at 6 Italian centers, undergoing fibrinogen concentration assessment at baseline, 2 hours and 6 hours after IVT. Fibrinogen depletion was defined as a reduction below 200 mg/dl after 2 hours from IVT, or as a reduction below 50% of baseline fibrinogen levels after 2 hours from IVT. Main outcomes were (i) sICH according to National Institute of Neurological Disorders and Stroke criteria, and (ii) major bleeding.
Results:
Overall, 1678 patients were included. sICH (n=116) and major bleeding (n=297) were associated with lower prevalence of good functional recovery (p<0.001). Despite similar fibrinogen levels at admission, fibrinogen depletion after 2 hours from IVT was more common in people with sICH and major bleeding. In the backward stepwise multivariable logistic regression model, fibrinogen depletion remained a significant predictor of sICH (OR 1.55, 95%CI 1.04-2.32) and major bleeding (OR 1.36, 95%CI 1.03-1.8)
Conclusions:
Fibrinogen depletion significantly increases the risk of sICH and major bleeding after IVT for acute ischemic stroke. Routine assessment of fibrinogen might be considered to stratify the risk of ICH.