Reimão, Sofia Cristina Pereira CoutinhoNeto, Lia Pereira LucasGonçalves, João Carlos Saramago Nobre2024-04-022024-04-022023-05http://hdl.handle.net/10451/63880Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023Introdução – Os Acidentes Vasculares Cerebrais (AVC) Isquémicos são a principal causa de morte em Portugal. O tratamento baseia-se na trombólise intravenosa e no tratamento endovascular(TEV). A pandemia COVID-19 teve bastante impacto mundial sobretudo nos sistemas de saúde. O objetivo principal do estudo foi avaliar o impacto desta pandemia no tratamento endovascular do AVC Isquémico Agudo. | Métodos – Estudo retrospetivo, a partir da base de dados do Serviço de Neuroimagiologia do Hospital Santa Maria (HSM), onde se registam todos os doentes ali submetidos a TEV. Foram selecionados os doentes sem infeção SARS-CoV-2 até 5 dias antes da intervenção, no período entre Março e Maio de 2020, comparando-os com os meses homólogos de 2019. Resultados – Foram incluídos 123 indivíduos sem infeção COVID, 68 de 2020 e 55 referentes a 2019; 51% dos indivíduos eram do sexo masculino e 49% do feminino, com uma idade média de 73 anos. As idades variaram em 2019 entre 39 e 96anos e em 2020 entre 21-91anos. O tempo desde os sintomas à admissão no HSM, aumentou 39 minutos em 2020 face ao período homólogo em 2019. Os tempos “Door-to-Needle” e “Door-to-Recanalization” aumentaram em 2020. Em relação às recanalizações bem-sucedidas, o número de casos com Thrombolysis In Cerebral Infarction scale (TICI)2C foi 15,55% superior em 2020 e a transformação hemorrágica às 24h reduziu 9,6%. Pacientes com escala de RANKIN modificada (mRS)2 aumentaram 6,5% em 2020 (p=0,540). O número de óbitos em internamento foi 5 vezes superior no grupo de 2020. Conclusão – As restrições impostas pela pandemia de COVID-19 exigiram adaptações constantes dos serviços de saúde, justificando assim o aumento dos tempos pré e intra-hospitalares. Apesar disso, os outcomes imagiológicos e de recanalização foram melhores em 2020, possivelmente devido aos avanços na TEV e à experiência acumulada dos neurorradiologistas de intervenção. No entanto, houve um aumento inexplicável de óbitos em internamento, que necessita de investigação dirigida.Introduction – The aim of this study is to assess the impact of the SARS-CoV-2 pandemic on non-COVID patients with acute ischaemic stroke, submitted to endovascular treatment (EVT). The impact was studied in terms of pre-hospital admission, inter-hospital transport and treatment, imaging, and clinical outcomes. Methods – Data was collected retrospectively between March and May 2020, which were compared to the same months in 2019. Patients with ischaemic stroke who underwent mechanical thrombectomy at the Neuroradiology Department of Hospital Santa Maria were selected. Those who had SARS-CoV-2 infection up to 5 days before the intervention and/or posterior circulation occlusion were excluded. 123 individuals were included, 55 from 2019 and 68 from 2020. Results – Sample population was represented by 51% male and 49% female patients, with a mean age of 73 years-old. During SARS-Cov-2 Pandemic there was an increase in the time between onset of symptoms and hospital admission by 39 minutes at Hospital Santa Maria (p=0.021) and 18 minutes at other hospitals (p=0.969). The “Door-to-Needle” and “Door-to-Recanalization” times increased by 23 (p=0.354) and 4 minutes (p=0.238), respectively. Regarding recanalization success rates, the number of cases with Thrombolysis In Cerebral Infarction scale (TICI)2C were 15.55% higher in 2020 (p=0.031) and haemorrhagic transformation at 24 hours decreased by 9.6% (p=0.388). Patients with modified RANKIN scale (mRS)2 increased by 6.5% in 2020 (p=0.540). However, in-hospital mortality increased fivefold in 2020 (p=0.031). Conclusion – The pandemic has caused a decrease in attendance to accident and emergency departments, resulting in increased time from onset of symptoms to hospital admissions. The restrictions imposed by the COVID-19 pandemic demanded a constant need to adapt healthcare services, hence justifying the increase in intra-hospital times. In spite of this, imaging and recanalization outcomes were better in 2020, possibly due to advancements in EVT and accumulated experience of interventional neuroradiologists. Nevertheless, there was an unexplained increase in in-hospital deaths, which could maybe be due to the need to divert resources to respond to the pandemic.porAVC isquémicoTrombectomiaSARS-CoV-2COVID-19Imagiologiamaster thesis203404009