• Aristeidis H Katsanos, Danielle de Sa Boasquevisque, Mustafa Ahmed Al-Qarni, Mays Shawawrah, Rhonda McNicoll-Whiteman, Linda Gould, Brian Van Adel, Demetrios J Sahlas, Kelvin Kuan Huei Ng, Kanjana Perera, Mukul Sharma, Wieslaw Oczkowski, Aleksandra Pikula, Ashkan Shoamanesh, and Luciana Catanese.
• Division of Neurology, Hamilton General Hospital-Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
• Can J Neurol Sci. 2021 Jan 1; 48 (1): 59-65.

BackgroundWe investigated the impact of regionally imposed social and healthcare restrictions due to coronavirus disease 2019 (COVID-19) to the time metrics in the management of acute ischemic stroke patients admitted at the regional stroke referral site for Central South Ontario, Canada.MethodsWe compared relevant time metrics between patients with acute ischemic stroke receiving intravenous tissue plasminogen activator (tPA) and/or endovascular thrombectomy (EVT) before and after the declared restrictions and state of emergency imposed in our region (March 17, 2020).ResultsWe identified a significant increase in the median door-to-CT times for patients receiving intravenous tPA (19 min, interquartile range (IQR): 14-27 min vs. 13 min, IQR: 9-17 min, p = 0.008) and/or EVT (20 min, IQR: 15-33 min vs. 11 min, IQR: 5-20 min, p = 0.035) after the start of social and healthcare restrictions in our region compared to the previous 12 months. For patients receiving intravenous tPA treatment, we also found a significant increase (p = 0.005) in the median door-to-needle time (61 min, IQR: 46-72 min vs. 37 min, IQR: 30-50 min). No delays in the time from symptom onset to hospital presentation were uncovered for patients receiving tPA and/or endovascular reperfusion treatments in the first 1.5 months after the establishment of regional and institutional restrictions due to the COVID-19 pandemic.ConclusionWe detected an increase in our institutional time to treatment metrics for acute ischemic stroke patients receiving tPA and/or endovascular reperfusion therapies, related to delays from hospital presentation to the acquisition of cranial CT imaging for both tPA- and EVT-treated patients, and an added delay to treatment with tPA.

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