CT perfusion in hyper-acute ischemic stroke: the acid test for COVID-19 fear

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.

e-Health solution for home patient telemonitoring in early post-acute TIA/Minor stroke during COVID-19 pandemic

“…Stroke is the second most common cause of death in the world after ischemic heart disease, as well as the most common cause of adult disability in developed countries [ 2 ]. During the first months of the pandemic emergency we observed a consistent reduction of admissions in our Hub Stroke Unit compared to the same period in 2019 [ 3 , 4 ], especially due to the lower number of transient ischemic attack (TIA) and minor strokes admission, which may have been related to the widespread fear of going to the hospital during the pandemia when showing mild or transient stroke symptoms. Similar findings were observed in other stroke units worldwide [ [5] , [6] , [7] ].…”

Value of 4D CT Angiography Combined with Whole Brain CT Perfusion Imaging Feature Analysis under Deep Learning in Imaging Examination of Acute Ischemic Stroke

“…Whole brain CTP is a functional imaging technology, which is also of great value for AIS. Functional maps and cerebral perfusion parameters obtained by different digital models can be used to find the changes of blood perfusion volume [ 11 , 12 ]. CTP imaging is widely used in patients with ultra-early AIS.…”