Patients Treated for Stroke During COVID-19 Pandemic Have Delayed Thrombolysis

Stroke. Colored three-dimensional MRA (magnetic resonance angiography) scan of internal bleeding (red, center right) in a stroke victim’s brain. Arteries are pink. The brain damage of a stroke (or CVA, cerebrovascular accident) results from pressure from the internal bleeding. The brain is seen from the front. The bleeding is in the left hemisphere of the brain, and has caused hemiplegia (paralysis) in the right half of the body, as well as aphasia (a speech disorder). MRA is a magnetic resonance imaging (MRI) technique that highlights blood vessels. For an MRA scan of a healthy brain, see image SB4129.
Study researchers investigated whether the COVID-19 pandemic potentially contributed to the delay in acute stroke care.

Treatment for stroke during the coronavirus disease 2019 (COVID-19) pandemic was associated with a significant delay in receiving thrombolysis compared with treatment prior to the pandemic, according to study results published in in Stroke.

Study researchers sought to determine whether the COVID-19 pandemic contributed to delays in acute stroke management and care. To achieve this, they conducted retrospective study based on a pooled analysis of clinical data of consecutive adult patients with stroke who were treated at 14 US comprehensive stroke centers between January 1, 2019 and July 31, 2020. Study researchers compared the rate of thrombolysis for non-transferred patients within the Target: Stroke goal of 60 minutes in 1491 patients who were admitted prior to the COVID-19 pandemic (March 1, 2019, to July 31, 2019) with that in 1464 patients admitted during the pandemic (March 1, 2020, to July 31, 2020).

Approximately 15% of patients underwent intravenous thrombolysis. Patients treated during the COVID-19 pandemic period had a lower odds of thrombolysis receipt within 60 minutes of arrival compared with patients treated prior to the pandemic (odds ratio [OR], 0.61; 95% CI, 0.38-0.98; P =.04). In patients treated during the pandemic, there was a median delay in door-to-needle time of 4 minutes (P =.03).

The lower odds of achieving treatment in the Target: Stroke goal persisted even following adjustment for variables associated with earlier therapy (adjusted OR, 0.55; 95% CI, 0.35-0.85; P <.01). Additionally, delay in thrombolysis continued through June and July.

Findings indicated that the primary factor contributing to the delay in thrombolysis was the longer delay from imaging to bolus (median, 29 vs 22 minutes; P =.02). Study researchers found no significant delay in door-to-groin puncture for patients who received thrombectomy (median, 83 vs 90 minutes; P =.30).

A limitation of the study included its retrospective nature, which may have resulted in missing data, including missing stroke diagnoses. Additionally, there was limited available data from each stroke center’s prospective registries.

“Because the delay in care appears driven largely by the time from image acquisition to thrombolysis initiation,” the study researchers concluded, “centers are encouraged to reevaluate their local paradigms to expedite stroke treatment once intracranial hemorrhage has been excluded.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Siegler JE, Zha AM, Czap AL, et al. Influence of the COVID-19 pandemic on treatment times for acute ischemic stroke: The Society of Vascular and Interventional Neurology Multicenter Collaboration. Stroke. Published online November 30, 2020. doi:10.1161/STROKEAHA.120.032789