Abstract P108: Impact of the Covid-19 Pandemic on Hyperacute Stroke Treatment: Experience From a Comprehensive Stroke Centre in Singapore

Background: The Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and affecting healthcare systems across the world. Singapore has escalated its alert level to Disease Outbreak Response System Condition (DORSCON) Orange, signifying severe disease with community spread. Objectives: We aimed to study the overall volume of AIS cases and the delivery of hyperacute stroke services during DORSCON Orange. Methods: This was a single-centre, observational cohort study performed at a comprehensive stroke centre responsible for AIS cases in the western region of Singapore, as well as providing care for COVID-19 patients. All AIS patients reviewed as an acute stroke activation in the Emergency Department (ED) from November 2019 to April 2020 were included. System processes timings, treatment and clinical outcome variables were collected. Results: We studied 350 AIS activation patients admitted through the ED, 206 (58.9%) pre- and 144 during DORSCON Orange. Across the study period, number of stroke activations showed significant decline (p =0.004, 95% CI 6.513 - -2.287), as the number of COVID-19 cases increased exponentially, whilst proportion of activations receiving acute recanalization therapy remained stable ( p = 0.519, 95% CI -1.605 - 2.702). Amongst AIS patients that received acute recanalization therapy, early neurological outcomes in terms of change in median NIHSS at 24 hours (-4 versus -4, p = 0.685) were largely similar between the pre- and during DORSCON orange periods. Conclusions: The number of stroke activations decreased while the proportion receiving acute recanalization therapy remained stable in the current COVID-19 pandemic in Singapore.

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Impact of the COVID-19 pandemic on hyperacute stroke treatment: experience from a comprehensive stroke centre in Singapore

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-020-02225-1 ◽

2020 ◽

Vol 50 (3) ◽

pp. 596-603 ◽

Cited By ~ 2

Author(s):

Prakash R. Paliwal ◽

Benjamin Y. Q. Tan ◽

Aloysius S. T. Leow ◽

Sunny Sibi ◽

Daniel W. P. Chor ◽

...

Keyword(s):

Stroke Treatment ◽

Treatment Experience ◽

Hyperacute Stroke ◽

Stroke Centre

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Trends in mortality of hospitalised COVID-19 patients: A single centre observational cohort study from Spain

The Lancet Regional Health - Europe ◽

10.1016/j.lanepe.2021.100041 ◽

2021 ◽

Vol 3 ◽

pp. 100041

Author(s):

Carolina Garcia-Vidal ◽

Alberto Cózar-Llistó ◽

Fernanda Meira ◽

Gerard Dueñas ◽

Pedro Puerta-Alcalde ◽

...

Keyword(s):

Cohort Study ◽

Observational Cohort Study ◽

Single Centre ◽

Observational Cohort

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Abstract P99: Impact of the Covid-19 Pandemic on Stroke Thrombolysis Rate and Delay to Thrombolysis Treatment in a Regional Stroke Centre in London, UK

Stroke ◽

10.1161/str.52.suppl_1.p99 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Brian Drumm ◽

Paul Bentley ◽

Zoe Brown ◽

Lucio D’Anna ◽

Tsering Dolkar ◽

...

Keyword(s):

Arrival Time ◽

Negative Impact ◽

Public Awareness ◽

Stroke Severity ◽

Time Intervals ◽

Neurological Outcomes ◽

Stroke Thrombolysis ◽

Prehospital Delays ◽

The Impact ◽

Stroke Centre

Introduction: There are reports of changes in the numbers of stroke admissions and time intervals to receiving emergency treatments during the COVID-19 pandemic. We examined the impact of the COVID-19 pandemic on the stroke thrombolysis rate and delay to thrombolysis treatment in a regional stroke centre in London, UK. Methods: COVID-19 testing began at our hospital on 3 March 2020. Clinical data for all acute stroke admissions were routinely collected as part of a national Sentinel Stroke National Audit Programme (SSNAP) and all thrombolysis data were entered into our local thrombolysis database. We retrospectively extracted the relevant patient data for the period of March to May 2020 (COVID group) and compared to the same period in 2019 (pre-COVID group). Results: Compared with pre-COVID, there was a 17.5% fall in total stroke admissions (from 315 to 260) during COVID; but there were no significant differences in the demographics, stroke severity, proportions with known time of onset, or median onset-to-arrival time. The thrombolysis rates amongst ischemic strokes were not significantly different between the two groups (59/260=23% pre-COVID vs. 41/228=18% COVID, p=.19). For thrombolysis patients, their stroke severity and demographics were similar between the two both groups. Median onset-to-needle time was significantly longer by 22 minutes during COVID [127 (IQR 94-160) vs. 149 (IQR 110-124) minutes, p=.045]; this delay to treatment was almost entirely due to a longer median onset-to-arrival time by 16 minutes during COVID (p=.029). Favorable early neurological outcomes post-thrombolysis (defined as an improvement in NIHSS by ≥4 points at 24 hours) were similar (45% vs. 46%, p=.86). Conclusion: COVID-19 pandemic had a negative impact on prehospital delays which in turn significantly increased onset-to-needle time, but without affecting the chance of a favorable early neurological outcome. Our data highlight the need to maintain public awareness of taking immediate action when stroke symptoms occur during the COVID-19 pandemic.

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SAT0624 Incidence and baseline characteristics of relapse or exacerbation in patients with pulmonary sarcoidosis: a single centre long-term observational cohort study

10.1136/annrheumdis-2018-eular.2745 ◽

2018 ◽

Author(s):

O. Murata ◽

A. Kudo ◽

K. Suzuki

Keyword(s):

Cohort Study ◽

Pulmonary Sarcoidosis ◽

Observational Cohort Study ◽

Single Centre ◽

Observational Cohort ◽

Baseline Characteristics

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Characteristics and predictors of treatment failure with intravenous tigecycline monotherapy among adult patients with severe Clostridioides (Clostridium) difficile infection: a single-centre observational cohort study

Diagnostic Microbiology and Infectious Disease ◽

10.1016/j.diagmicrobio.2020.115231 ◽

2021 ◽

Vol 99 (2) ◽

pp. 115231

Author(s):

Balint Gergely Szabo ◽

Lilla Duma ◽

Katalin Szidonia Lenart ◽

Rebeka Kiss ◽

Eszter Vad ◽

...

Keyword(s):

Cohort Study ◽

Clostridium Difficile ◽

Treatment Failure ◽

Clostridium Difficile Infection ◽

Observational Cohort Study ◽

Adult Patients ◽

Single Centre ◽

Observational Cohort

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Remnant lipoproteins play an important role of in-stent restenosis in type 2 diabetes undergoing percutaneous coronary intervention: a single-centre observational cohort study

Cardiovascular Diabetology ◽

10.1186/s12933-019-0819-z ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 9

Author(s):

Zheng Qin ◽

Kuo Zhou ◽

Yue-ping Li ◽

Jian-long Wang ◽

Wan-jun Cheng ◽

...

Keyword(s):

Coronary Intervention ◽

Observational Cohort Study ◽

Single Centre ◽

Stent Restenosis ◽

Remnant Lipoproteins ◽

Percutaneous Coronary ◽

Observational Cohort ◽

In Stent Restenosis

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Stroke in COVID-19: a single-centre initial experience in a hotspot of the pandemic

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000525 ◽

2020 ◽

Vol 5 (4) ◽

pp. 331-336 ◽

Cited By ~ 1

Author(s):

Ivo Bach ◽

Pratibha Surathi ◽

Nora Montealegre ◽

Osama Abu-Hadid ◽

Sara Rubenstein ◽

...

Keyword(s):

Respiratory Symptoms ◽

Mechanical Thrombectomy ◽

Clinical Laboratory ◽

Severe Disease ◽

Nasopharyngeal Swab ◽

Single Centre ◽

Vessel Occlusion ◽

Global Pandemic ◽

Imaging Characteristics ◽

Intravenous Alteplase

BackgroundCOVID-19, caused by SARS-CoV-2, is a global pandemic that has been an immense burden on healthcare systems all over the world. These patients may be at higher risk for acute ischaemic stroke (AIS). We present our experience with AIS in patients with COVID-19.MethodsWe reviewed all patients admitted to our hospital during a 6-week period with a positive nasopharyngeal swab test for SARS-CoV-2. Among these patients, we identified AIS. We reviewed the demographics, clinical, laboratory, imaging characteristics, treatments received and outcomes of AIS in patients with COVID-19.ResultsWe identified 683 patients admitted with COVID-19 during the study period, of which 20 patients had AIS. Large-vessel occlusion (LVO) was noted in 11 patients (55%). Intravenous alteplase was administered in four patients (20%) and mechanical thrombectomy was performed in five patients (25%). Respiratory symptoms preceded the onset of AIS in most of the patients (70%) by 1 to 21 days. Mortality in patients with AIS was 50% compared with 26% of all COVID-19 admissions. Most of these patients died due to non-neurological causes (70%). Three patients with AIS had clinical and imaging findings consistent with COVID-19, but were negative for multiple nasopharyngeal swab tests.InterpretationLVO was more common in patients with AIS and COVID-19. They had more severe disease and higher mortality rates. Most of the patients had respiratory symptoms preceding AIS by days to weeks. This could explain certain patients with clinical picture of COVID-19 but negative nasopharyngeal swab tests.

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Localized Brain Tissue Cooling for Use During Intracranial Thrombectomy

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80083 ◽

2012 ◽

Author(s):

Thomas L. Merrill ◽

Denise R. Merrill ◽

Jennifer E. Akers

Keyword(s):

Ischemic Stroke ◽

Reperfusion Injury ◽

Brain Tissue ◽

Ischemic Injury ◽

Blood Perfusion ◽

Neuroprotective Agents ◽

Tissue Necrosis ◽

Stroke Treatment ◽

Neurological Outcomes

The primary goal of current ischemic stroke treatment is quickly restoring blood perfusion. Recanalization is linked to improved neurological outcomes [1]. Resulting tissue necrosis, however, following a stroke has two causes: 1) ischemic injury and 2) reperfusion injury. Therefore, development of neuroprotective agents specifically beneficial against reperfusion injury are required.

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