Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events A 1-Year Follow-up

Authors	NGUYEN Thanh N QURESHI Muhammad M KLEIN Piers YAMAGAMI Hiroshi MIKULÍK Robert CZLONKOWSKA Anna ABDALKADER Mohamad ŠEDOVÁ Petra SATHYA Anvitha LO Hannah C MANSOUR Ossama Yassin VANGURU Husitha Reddy LESAINE Emilie TSIVGOULIS Georgios LOOCHTAN Aaron I DEMEESTERE Jelle UCHINO Ken INOA Violiza GOYAL Nitin CHARIDIMOU Andreas SIEGLER James E YAGHI Shadi AGUIAR de Sousa Diana MOHAMMADEN Mahmoud H HAUSSEN Diogo C KRISTOFFERSEN Espen Saxhaug LEREIS Virginia Pujol SCOLLO Sergio Daniel CAMPBELL Bruce C V MA Alice THOMAS James Orton PARSONS Mark W SINGHAL Shaloo SLATER Lee-Anne MARTINS Rodrigo Tomazini ENZINGER Chris GATTRINGER Thomas RAHMAN Aminur BONNET Thomas LIGOT Noemie SYLVIE De Raedt LEMMENS Robin VANACKER Peter VANDERVORST Fenne CONFORTO Adriana Bastos HIDALGO Raquel C T NEVES Luciana de Oliveira MARTINS Rodrigo Targa LILIANA Mora Cuervo Daissy REBELLO Leticia C SANTIAGO Igor Bessa LAMEIRINHAS da Silva Isabelle SAKELAROVA Teodora KALPACHKI Rosen ALEXIEV Filip CATANESE Luciana CORA Elena Adela GOYAL Mayank HILL Michael D KELLY Michael E KHOSRAVANI Houman LAVOIE Pascale PEELING Lissa PIKULA Aleksandra RIVERA Rodrigo CHEN Hui-Sheng CHEN Yimin HUO Xiaochuan MIAO Zhongrong YANG Shuiquan BEDEKOVIC Marina Roje BRALIC Marina BUDINCEVIC Hrvoje CORREDOR-QUINTERO Angel Basilio LARA-SARABIA Osvaldo E CABAL Martin TENORA Dusan FIBRICH Petr HERZIG Roman HRABANOVSKA Emanuela HLINOVSKY David JURAK Lubomir KADLCIKOVA Jana KARPOWICZ Igor KLECKA Lukas KOVAR Martin LAUER David NEUMANN Jiri PALOUSKOVA Hana REISER Martin REKOVA Petra ROHAN Vladimir SKODA Ondrej ŠKORŇA Miroslav SRAMEK Martin ZAKOVA Lenka CHRISTENSEN Hanne DRENCK Nicolas IVERSEN Helle Klingenberg TRUELSEN Thomas Clement WIENECKE Troels SOBH Khalid YLIKOTILA Pauli ALPAY Kemal STRBIAN Daniel BERNADY Patricia CASENAVE Philippe DAN Maria FAUCHEUX Jean-Marc GENTRIC Jean-Christophe MAGRO Elsa SABBEN Candice REINER Peggy ROUANET Francois BOHMANN Ferdinand O BOSKAMP Stefan MBROH Joshua NAGEL Simon NOLTE Christian H RINGLEB Peter A ROSENKRANZ Michael POLI Sven THOMALLA Gotz KARAPANAYIOTIDES Theodoros KOUTROULOU Ioanna KARGIOTIS Odysseas PALAIODIMOU Lina DOMINGUO Barrientos Guerra Jose HUDED Vikram MENON Bindu NAGENDRA Shashank PRAJAPATI Chintan SYLAJA P N PRAMANA Nyoman Angga Krishna SANI Achmad Firdaus GHOREISHI Abdoreza FARHOUDI Mehdi HOKMABADI Elyar Sadeghi TARIQ Abu Raya KALMANOVICH Shani Avnery RONEN Levite SABETAY Sergiu Ionut ACAMPA Maurizio ADAMI Alessandro CASTELLAN Lucio LONGONI Marco ORNELLO Raffaele RENIERI Leonardo BIGLIANI Claudia Rolla ROMOLI Michele SACCO Simona SALMAGGI Andrea SANGALLI Davide ZINI Andrea DOIJIRI Ryosuke FUKUDA Hiroki FUJINAKA Toshiyuki FUJITA Kyohei IMAMURA Hirotoshi SAKAI Nobuyuki KANAMARU Takuya KIMURA Naoto KONO Ryuhei MIYAKE Kosuke SAKAGUCHI Manabu SAKAI Kenichiro SONODA Kazutaka TODO Kenichi MIYASHITA Fumio TOKUDA Naoki MATSUMARU Yuji MATSUMOTO Shoji OHARA Nobuyuki SHINDO Seigo TAKENOBU Yohei YOSHIMOTO Takeshi TOYODA Kazunori UWATOKO Takeshi YAGITA Yoshiki YAMADA Takehiro YAMAMOTO Nobuaki YAMAMOTO Ryoo YAZAWA Yukako SUGIURA Yuri WAWERU Peter Kuria BAEK Jang-Hyun LEE Si Baek SEO Kwon-Duk SOHN Sung-Il ARSOVSKA Anita Ante CHAN Yong Chieh ZAIDI Wan Asyraf Wan JAAFAR Ainul Syahrilfazli GONGORA-RIVERA Fernando MARTINEZ-MARINO Manuel INFANTE-VALENZUELA Adrian GROPPA Stanislav LEAHU Pavel COUTINHO Jonathan M RINKEL Leon A DIPPEL Diederik W J VAN DAM-NOLEN Dianne H K RANTA Annemarei WU Teddy Y ADEBAYO Tajudeen Temitayo BELLO Abiodun H NWAZOR Ernest Okwundu SUNMONU Taofiki Ajao WAHAB Kolawole Wasiu RONNING Ole Morten SANDSET Else Charlotte AL HASHMI Amal M AHMAD Saima RASHID Umair RODRIGUEZ-KADOTA Liliana YALUNG Patrick Matic DY Jon Stewart Hao PINEDA-FRANKS Maria Carissa CO Christian Oliver BROLA Waldemar DEBIEC Aleksander DOROBEK Malgorzata KARLINSKI Michal Adam LABUZ-ROSZAK Beata M LASEK-BAL Anetta SIENKIEWICZ-JAROSZ Halina STASZEWSKI Jacek SOBOLEWSKI Piotr WIACEK Marcin ZIELINSKA-TUREK Justyna ARAUJO Andre Pinho ROCHA Mariana CASTRO Pedro CRUZ Vitor Tedim FERREIRA Paulo Venancio FERREIRA Patricia NUNES Ana Paiva FONSECA Luisa MARTO Joao Pedro TERESA Pinho e Melo RODRIGUES Miguel SILVA M Luis DIMITRIADE Adela FALUP-PECURARIU Cristian HAMID May Adel VENKETASUBRAMANIAN Narayanaswamy KRASTEV Georgi MAKO Miroslav AYO-MARTIN Oscar HERNANDEZ-FERANDEZ Francisco BLASCO Jordi RODRIGUEZ-VAZQUEZ Alejandro CRUZ-CULEBRAS Antonio MONICHE Francisco MONTANER Joan PEREZ-SANCHEZ Soledad JESAS Garcia Sanchez Maria MARTA Guillan Rodriguez JOOD Katarina NORDANSTIG Annika MAZYA Michael V MOREIRA Tiago T P BERNAVA Gianmarco BEYELER Morin BOLOGNESE Manuel CARRERA Emmanuel DOBROCKY Tomas KARWACKI Grzegorz Marek KELLER Emanuela HSIEH Chang Yang BOONYAKARNKUL Surawan CHUROJANA Anchalee AYKAC Ozlem OZDEMIR Atilla Azcan BAJRAMI Arsida SENADIM Songul HUSSAIN Syed Irteza JOHN Seby BANERJEE Soma KWAN Joseph KRISHNAN Kailash LENTHALL Robert MATTHEWS Ashok WONG Ken ZHANG Liqun ALTSCHUL Dorothea ASIF Kaiz S BAHIRU Zeelalem BELOW Kristine RULAND Sean CHAUDRY Saqib A CHEN Michael CHEBL Alex CIBULKA Jackie CISTRUNK Leon CLARK Judith COLASURDO Marco CZAP Alexandra ADAM de Havenon AMATO Salvatore DHARMADHIKARI Sushrut GRIMMETT Kasey B DMYTRIW Adam A ETHERTON Mark R EZEPUE Chizoba FAROOQUI Mudassir FESKE Steven K FINK Lauren GASIMOVA Ulviyya GUZIK Amy K HAKEMI Maryam HOVINGH Majesta KHAN Muhib JILLELA Dinesh KHATRI Rakesh KHAWAJA Ayaz M KHOURY Naim N KILEY Nicole L KIM Benny S KOLIKONDA Murali K KUHN Anna Luisa LARA Stephanie LINARES Guillermo LINFANTE Italo LUKOVITS Timothy G LYCAN Sarah MALE Shailesh S MAALI Laith MANCIN John MASOUD Hesham MOHAMED Ghada A MONTEIRO Andre NAHAB Fadi NALLEBALLE Krishna ORTEGA-GUTIERREZ Santiago PURI Ajit S RADAIDEH Yazan RAHANGDALE Rahul H RAI Ansaar RAMAKRISHNAN Pankajavalli REDDY Aravind B ROJAS-SOTO Diana M ROMERO Jose Rafael ROST Natalia S ROTHSTEIN Aaron OMRAN Setareh Salehi SHETH Sunil A SIDDIQUI Adnan H STAROSCIAK Amy K TARLOV Nicholas E TAYLOR Robert A WANG Michael J WOLFE Jared WONG Ka-Ho LE Huynh Vu NGUYEN Quy Viet PHAM Thong Nhu NGUYEN Trung Thanh PHAN Hoang Thi TON Mai Duy FISCHER Urs MICHEL Patrik STRAMBO Davide MARTINS Sheila O ZAIDAT Osama O NOGUEIRA Raul G
Year of publication	2023
Type	Article in Periodical
Magazine / Source	Neurology
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://n.neurology.org/content/100/4/e408
Doi	http://dx.doi.org/10.1212/WNL.0000000000201426
Keywords	COVID-19 Pandemic; Stroke Volumes; Cerebrovascular Events
Description	Background and Objectives Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). Methods We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1–6.9]; p < 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1–4.6]; p < 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4–5.8]; p < 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p < 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6–0.9]; p = 0.49). Stroke was diagnosed in 1.3% [1.31–1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82–2.97], 5,656/195,539) of all stroke hospitalizations. Discussion There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.