We aim to compare the incidence and timing of complications in stroke patients over the first 24 hours post-reperfusion therapies and their association to hospital unit in 2019, 2020 and 2021.

Monitoring stroke patients in critical-care units for 24 hours after thrombolysis or thrombectomy is considered standard of care but is not evidence-based. Due to the Covid-19 pandemic, our center modified its protocol in April 2021 with 24-hour critical-care monitoring no longer being guaranteed for stroke patients.

We retrospectively collected data from stroke patients treated with thrombolysis or thrombectomy at our center in 2019 (pre-Covid-19, standard of care), 2020 (during Covid-19, standard of care) and 2021 (during Covid-19, new protocol). Data extracted included demographics, the nature and timing of complications within the first 24 hours, and the unit at the time of complication. Major complications included symptomatic intracranial hemorrhage (sICH), recurrent stroke, myocardial infarction, systemic bleeding, RACE call, and death.

Three hundred forty-nine patients were included in our study: 156 patients in 2021, 115 patients in 2020, and 78 patients in 2019. In 2021, 54 (34.6%) patients had, at least, one complication within the first 24 hours compared to 39 (33.9%) in 2020 and 24 (30.8%) in 2019. Forty-eight (88.9%) of the complications in 2021 occurred in a critical-care unit compared to 37 (94.9%) in 2020 and 17 (70.8%) in 2019. Overall, 61.5% of complications and 50.0% of sICH occurred within 12h. In 2021, 74.1% of all complications and 100% of sICH occurred within 12h.

Despite the change of protocol in April 2021, the incidence and timing of complications did not significantly change compared to prior years and was not associated to hospital units. Most complications occurred in the first 12 hours. Further research is required to evaluate the necessity of intensive care monitoring for 24 hours in this population.