Reduced Admissions for Cerebrovascular Events During COVID-19 Outbreak in Italy
Authors: Sacco Simona , Ricci Stefano , Ornello Raffaele , Eusebi Paolo , Petraglia Luca , Toni Danilo , Rota Eugenia , Bruzzone Gianluca , Testa Lucia , Bongioanni Roberta , Rosso Mara , Labate Carmelo , Tarletti Roberto , Cantello Roberto , Fleetwood Thomas , Melis Fabio , Imperiale Daniele , Amarù Salvatore , Reggiani Monica , Ruiz Luigi , Cipriano Elia , Ferrandi Delfina , Julita Patrizia , Africa Liana , Meinieri Piero , Grasso Maria Federica , Servo Serena , Cavallo Roberto , Chianale Gigliola , Naldi Andrea , Cerrato Paolo , Rubino Elisa , Giossi Alessia , Puglisi Valentina , Vinciguerra Luisa , Santilli Ignazio , Bordo Bianca Maria , Marcheselli Simona , Bottini Julia , D’Alessandro Caterina Mariotto , Micieli Giuseppe , Cavallini Anna , Canavero Isabella , Muscia Francesco , Nuzzaco Graziamaria , Ciccone Alfonso , Silvestrelli Giorgio , Salmaggi Andrea , Sangalli Davide , Zanferrari Carla , Fanucchi Simona , Ranieri Michela , Beretta Simone , Ferrarese Carlo , Pasini Francesco , Santangelo Francesco , Checcarelli Nicoletta , Beretta Sandro , Bazzi Paola , Camerlingo Massimo , Tognozzi Marcello , Caneve Giorgio , Adami Alessandro , Quatrale Rocco , Critelli Adriana , Bartolomei Luigi , Masato Maela , Perini Francesco , De Boni Antonella , Disco Caterina , Baracchini Claudio , Pieroni Alessio , Lerario Roberto , Russo Monia , Polo Alberto , Danese Alessandra , Valentinis Luca , Baldi Antonio , Tonello Simone , Paladin Francesco , Tonon Agnese , Bonetti Bruno , Cappellari Manuel , Teatini Francesco , Dossi Roberto Currò , Franchini Enrica , Giometto Bruno , Bignamini Valeria , Manganotti Paolo , Naccarato Marcello , Gigli Gian Luigi , Lorenzut Simone , Merlino Giovanni , Valente Mariarosaria , Rana Michele , Gentile Carolina , Tassinari Tiziana , Sugo Annalisa , Saia Valentina , Balestrino Maurizio , Coccia Alberto , Finocchi Cinzia , Valzania Franco , Zedde Maria Luisa , Toschi Giulia , Longoni Marco , Paolucci Matteo , Tugnoli Valeria , Querzani Pietro , Padroni Marina , Meletti Stefano , Bigliardi Guido , Dall’Acqua Maria Luisa , Zini Andrea , Gentile Mauro , Migliaccio Ludovica , Chiti Alberto , Tassi Rossana , Martini Giuseppe , Nencini Patrizia , Lamassa Maria , Mancuso Michelangelo , Orlandi Giovanni , Ferrari Elena , Marconi Roberto , Gallerini Simone , Groggia Vincenzo , Volpi Gino , Menichetti Chiara , Spolveri Stefano , Silvestrini Mauro , Viticchi Giovanna , Buratti Laura , Pelliccioni Giuseppe , Potente Eleonora , Mazzoli Tatiana , Marsili Erica , Cenciarelli Silvia , Picchioni Antonella , Costantini Franco , Colosimo Carlo , Paciaroni Maurizio , Caso Valeria , Rasura Maurizia , Beccia Mario , Falcone Nicola , Di Stefano Marisa , Cecconi Emanuela , Anticoli Sabrina , Pezzella Francesca Romana , Mangiardi Marilena , Plocco Maurizio , Magarelli Maria , Saggese Carlo Emanuele , Berto Irene , Altavista Maria Concetta , Roberti Cinzia , Diomedi Marina , Sallustio Fabrizio , Rocco Alessandro , Cupini Letizia Maria , Bonaffini Novella , De Angelis Maria Vittoria , Digiovanni Anna , Rispoli Marianna , Orlandi Berardino , Santis Federica De , Colangeli Enrico , Blasio Francesco Di , Carmine Caterina Di , Tocco Pierluigi , Melis Maurizio , Moller Jessica , Saddi Valeria , Manca Antonio , Baule Antonio , Caddeo Antonello , Iorio Nicola , Napoletano Rosa , di Gregorio Maria , Volpe Giampiero , D’Onofrio Florindo , Spitaleri Daniele , Barbarini Leonardo , Barbagallo Gaetano , Caggiula Marcella , Ardito Bonaventura , Noia Domenico Di , Viesti Pietro Di , Leone Maurizio Angelo , Inchingolo Vincenzo , Petruzzellis Marco , Rizzo Federica , Savarese Mariantonietta , Petrone Alfredo , Galati Franco , Arcudi Luciano , Branca Damiano , Aridon Paolo , Arnao Valentina , Musolino Rosa , Dell’Aera Cristina , Francalanza Isabella , Grimaldi Luigi , Arnao Valentina , Gammino Matilde , Giordano Antonello , Zelante Giuseppe , Sanzaro Enzo , Gasparro Antonio 
Published: October 2020

Background and Purpose:
We aimed to investigate the rate of hospital admissions for cerebrovascular events and of revascularization treatments for acute ischemic stroke in Italy during the coronavirus disease 2019 (COVID-19) outbreak.

Methods:
The Italian Stroke Organization performed a multicenter study involving 93 Italian Stroke Units. We collected information on hospital admissions for cerebrovascular events from March 1 to March 31, 2020 (study period), and from March 1 to March 31, 2019 (control period).

Results:

Ischemic strokes decreased from 2399 in 2019 to 1810 in 2020, with a corresponding hospitalization rate ratio (RR) of 0.75 ([95% CI, 0.71–0.80]
P
<0.001); intracerebral hemorrhages decreased from 400 to 322 (hospitalization RR, 0.81 [95% CI, 0.69–0.93];
P
=0.004), and transient ischemic attacks decreased from 322 to 196 (hospitalization RR, 0.61 [95% CI, 0.51–0.73];
P
<0.001). Hospitalizations decreased in Northern, Central, and Southern Italy. Intravenous thrombolyses decreased from 531 (22.1%) in 2019 to 345 in 2020 (19.1%; RR, 0.86 [95% CI, 0.75–0.99];
P
=0.032), while primary endovascular procedures increased in Northern Italy (RR, 1.61 [95% CI, 1.13–2.32];
P
=0.008). We found no correlation (
P
=0.517) between the hospitalization RRs for all strokes or transient ischemic attack and COVID-19 incidence in the different areas.

Conclusions:
Hospitalizations for stroke or transient ischemic attacks across Italy were reduced during the worst period of the COVID-19 outbreak. Intravenous thrombolytic treatments also decreased, while endovascular treatments remained unchanged and even increased in the area of maximum expression of the outbreak. Limited hospitalization of the less severe patients and delays in hospital admission, due to overcharge of the emergency system by COVID-19 patients, may explain these data.