Impact of COVID-19 pandemic on stroke endovascular treatment in P. Stradins Clinical University Hospital

Patients with acute ischemic stroke (AIS) due to a large vessel occlusion in Latvia are delivered to the endovascular treatment (ET) in two pathways optimizing patient transport (drip and ship (DS) or mothership (MS)). DS pathway in P. Stradins CUH has been launched since 2018. The World Health Organization declared a COVID19 pandemic in March 2020. In this study we evaluate endovascular treatment outcomes before and during the pandemic. We included AIS patients admitted to P. Stradins CUH, Riga, Latvia that received ET between 2018 and 2020. We collected the data about transportation pathway, administration of intravenous thrombolysis (TL), onset-to-groin time and functional outcome on discharge. Satisfactory outcome was defined as patients that achieved functional independence (modified Rankin scale (mRS) 0-2). We compared the results between pre-pandemic (01.01.2018.-29.02.2020.) and during the pandemic (01.03.2020.-31.12.2020.) periods. Total patients included 414 (265 pre-pandemic and 149 pandemic). Pre-pandemic: MS- 215 patients, ET+TL 73.0% (157), average onset-to-groin 233.7 min, mRS 0-2 27.9% (60) DS- 50 patients, ET+TL 70.0% (35), average onset-to-groin 292.7 min, mRS 0-2 24.0% (12) During the pandemic: MS- 103 patients, ET+TL 63.1% (65), average onset-to-groin 256.0 min, mRS 0-2 22.3% (23) DS- 46 patients, ET+TL 78.3% (36), average onset-to-groin 311.0 min, mRS 0-2 23.9% (11) During COVID19 pandemic average onset-to-groin time increased in both patient groups - ship and drip and mothership pathway. Combined reperfusion therapy (endovascular treatment plus intravenous thrombolysis) was performed less in the mothership group, presumably because of the higher rate of contraindications for intravenous thrombolysis. Satisfactory functional outcome (mRS 0-2) decreased in mothership group compared to pre-pandemic period.