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. 2021;50(6):707-714.
doi: 10.1159/000516908. Epub 2021 Jun 25.

COVID-19 Impact on Acute Ischemic Stroke Treatment at 9 Comprehensive Stroke Centers across Los Angeles

M Maximillian Padrick  1 , Navdeep Sangha  2 , Laurie Paletz  3 , James Mirocha  4 , Sonia Figueroa  3 , Vicki Manoukian  3 , Konrad Schlick  3 , Patrick D Lyden  5 , David S Liebeskind  6 , Fiona K Chatfield  6 , Jason W Tarpley  7   8 , Adrian Burgos  9 , Matthew Tenser  10   11 , Denise Gaffney  2 , Marco A Pech  12 , Edward Nazareth  12 , Robert Jackson  7 , Helaine Kauffman  7   8   12 , Lisa Arnold  7 , Jennifer Cox  13 , Treasure Joyce  8 , Catrice Nakamura  8 , Darcie Fitzgerald  8 , Kyle Ogami  3 , Nili Steiner  3 , Nicole Wolber  3 , Betty Robertson  3 , Rachel Izzo  3 , Stefanie Gorski  9 , Heather Manuel  9 , Krystal Valdez  8   10 , Liliana Reyes  10 , Latisha K Sharma  5 , Shlee S Song  3
Affiliations

COVID-19 Impact on Acute Ischemic Stroke Treatment at 9 Comprehensive Stroke Centers across Los Angeles

M Maximillian Padrick et al. Cerebrovasc Dis. 2021.

Abstract

Objective: To describe the impact of COVID-19 on acute cerebrovascular disease care across 9 comprehensive stroke centers throughout Los Angeles County (LAC).

Methods: Volume of emergency stroke code activations, patient characteristics, stroke severity, reperfusion rates, treatment times, and outcomes from February 1 to April 30, 2020, were compared against the same time period in 2019. Demographic data were provided by each participating institution.

Results: There was a 17.3% decrease in stroke code activations across LAC in 2020 compared to 2019 (1,786 vs. 2,159, respectively, χ2 goodness of fit test p < 0.0001) across 9 participating comprehensive stroke centers. Patients who did not receive any reperfusion therapy decreased by 16.6% in 2020 (1,527) compared to 2019 (1,832). Patients who received only intravenous thrombolytic (IVT) therapy decreased by 31.8% (107 vs. 157). Patients who received only mechanical thrombectomy (MT) increased by 3% (102 vs. 99). Patients who received both IVT and MT decreased by 31.8% (45 vs. 66). Recanalization treatment times in 2020 were comparable to 2019. CSCs serving a higher proportion of Latinx populations in the eastern parts of LAC experienced a higher incidence of MT in 2020 compared to 2019. Mild increase in stroke severity was seen in 2020 compared to 2019 (8.95 vs. 8.23, p = 0.046). A higher percentage of patients were discharged home in 2020 compared to 2019 (59.5 vs. 56.1%, p = 0.034), a lower percentage of patients were discharged to skilled nursing facility (16.1 vs. 20.7%, p = 0.0004), and a higher percentage of patients expired (8.6 vs. 6.3%, p = 0.008).

Conclusion: LAC saw a decrease in overall stroke code activations in 2020 compared to 2019. Reperfusion treatment times remained comparable to prepandemic metrics. There has been an increase in severe stroke incidence and higher volume of thrombectomy treatments in Latinx communities within LAC during the pandemic of 2020. More patients were discharged home, less patients discharged to skilled nursing facilities, and more patients expired in 2020, compared to the same time frame in 2019.

Keywords: COVID; Door-to-groin puncture time; Door-to-needle time; Ischemic stroke; Los Angeles; Reperfusion; Treatment.

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Conflict of interest statement

Jason W. Tarpley, MD, is a consultant for Medtronic − Modest. Otherwise, the authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Individual CSC change in reperfusion therapy rate. Forest plot showing percentage change of patients treated with IVT, MT, and combined IVT + MT as reported by each participating comprehensive stroke center. IVT, intravenous thrombolysis; MT, mechanical thrombectomy.
Fig. 2
Fig. 2
Regional change in patients receiving reperfusion therapies. a The percentage change in number of patients treated with IVT (milder symptoms, presenting within 4.5 h of symptom onset) in 2020 as compared to 2019. b The percentage change in number of patients treated with MT alone (more severe presentations, presenting within 24 h of symptom onset). c Combined IVT and MT (more severe presentations within 4.5 h of symptom onset). IVT, intravenous thrombolysis; MT, mechanical thrombectomy.
See this image and copyright information in PMC

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