1. CT perfusion in hyper-acute ischemic stroke: the acid test for COVID-19 fear
- Author
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Alex Buoite Stella, Miloš Ajčević, Roberta Pozzi Mucelli, Agostino Accardo, Sasha Olivo, Maria Assunta Cova, Carlo Lugnan, Giovanni Furlanis, Ilario Scali, Paola Caruso, Paolo Manganotti, Marcello Naccarato, Furlanis, G., Ajcevic, M., Scali, I., Buoite Stella, A., Olivo, S., Lugnan, C., Caruso, P., Pozzi Mucelli, R. A., Accardo, A., Cova, M. A., Naccarato, M., and Manganotti, P.
- Subjects
medicine.medical_specialty ,Neurology ,Coronavirus disease 2019 (COVID-19) ,Perfusion Imaging ,Coronaviru ,Clinical Neurology ,Perfusion scanning ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Image processing ,Internal medicine ,medicine ,Coronavirus ,COVID ,CT perfusion ,Perfusion pattern ,Stroke ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Pandemics ,Neuroradiology ,Diagnostic Neuroradiology ,Ischemic Stroke ,business.industry ,SARS-CoV-2 ,COVID-19 ,Retrospective cohort study ,Fear ,medicine.disease ,Perfusion ,Radiology Nuclear Medicine and imaging ,Communicable Disease Control ,Cardiology ,Neurology (clinical) ,Neurosurgery ,business ,Cardiology and Cardiovascular Medicine ,Tomography, X-Ray Computed ,030217 neurology & neurosurgery - 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.
- Published
- 2021