SIENA, Italy (AP) — Italian race car champion-turned-Paralympic gold medalist Alex Zanardi remained in serious condition a day after crashing his handbike into a truck and smashing his face.

Zanardi was hooked up to an artificial ventilator and had “stable” blood flow while his neurological status “remains serious,” the Santa Maria alle Scotte hospital in Siena said Saturday in a medical bulletin.

“The condition of Alex Zanardi is serious but stable,” surgeon Giuseppe Olivieri said in a briefing outside the hospital. “He arrived here with major facial cranial trauma — a smashed face.”

“The numbers are good, although it remains a very serious situation,” Olivieri added.

Zanardi was transported by helicopter to the hospital after crashing near the Tuscan town of Pienza during a relay race Friday.

Local TV at the scene of the crash showed what was apparently Zanardi’s handbike lying on its side at the edge of the road and a large truck pulling a semitrailer parked ahead.

Late Friday, the hospital said Zanardi underwent “a delicate neurosurgery operation” due to “severe cranial trauma.”

The surgery lasted about three hours, after which Zanardi was moved to the intensive care unit.

“We won’t see what his neurological state is until he wakes up. Improvement takes time in these cases. Turns for the worse can be sudden,” Olivieri said. “The operation went according to the plan. It’s the initial situation that was very serious.”

Zanardi’s wife, Daniela, and his son, Niccolò, are at his bedside.

The 53-year-old Zanardi won two championships in CART in the United States before a brief move to Formula One. He returned to America and was racing in Germany in a CART event in 2001 when both of his legs were severed in a horrific accident the weekend after the Sept. 11 terrorist attacks.

During his recovery, Zanardi designed his own prosthetics and learned to walk again. He then turned his attention to hand cycling and developed into one of the most accomplished athletes in the world. He won four gold medals and two silvers at the 2012 and 2016 Paralympics, competed in the New York City Marathon and set an Ironman record in his class.

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