Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events

Abstract

Background and Objectives:Declines in stroke admission, intravenous thrombolysis, 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 impact of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), intravenous thrombolysis (IVT), and mechanical thrombectomy over a one-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, intravenous thrombolysis 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 one-year immediately before compared to 138,453 admissions during the one-year pandemic, representing a 7% decline (95% confidence interval [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 to 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 to 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.Trial Registration Information:This study is registered underNCT04934020.

International study: Global impact of COVID-19 on stroke care — the Polish contribution

“…As an example of international collaboration between stroke centres, Prof. Raul G. Nogueira, Director of the University of Pittsburgh Medical Centre (UPMC)'s Stroke Institute, initiated several studies on the course of cerebrovascular disease and the organisation of care provided to patients during the COVID-19 pandemic in relation to analogous parameters before the pandemic [8][9][10][11][12]. UPMC is an important stroke centre for patient care, teaching, clinical and basic research in several areas of neurology, including stroke, and Prof. Nogueira has played a global leadership role in many landmark stroke thrombectomy trials.…”

“…To assess the global impact of the pandemic on stroke hospitalisations and outcomes, Prof. Nogueira inspired the international community of neurologists and neurointerventionalists from six continents, 70 countries and almost 500 hospital stroke centres to participate in large cross-sectional, observational, retrospective studies [8][9][10][11][12][13][14][15]. As highlighted in an editorial by Prof. Bart M. Demaerschalk entitled: 'Where in the World Have All the Strokes Gone?'…”

“…After the first wave of the pandemic, a later study entitled: 'Global impact of the COVID-19 pandemic on stroke volumes and cerebrovascular events: One-year follow-up' compared the period from 1 March 2020 to 28 February 2021 to the year before (i.e. 1 March 2019 to 29 February 2020) [9]. Volume data was obtained for COVID-19 admissions and for four stroke metrics: ischaemic stroke and intracranial haemorrhage (ICH) admissions, IVT and mechanical thrombectomy procedures from 275 stroke centres in 56 countries.…”

Neuroimaging findings and neurological manifestations in hospitalized COVID-19 patients: Impact of cancer and ventilatory support status

“…Another recent meta-analysis found numerous neurological manifestations associated with both the CNS and PNS, including headache, cerebrovascular diseases, altered mental status, encephalopathy, encephalitis, movement disorders, and Guillain-Barre syndrome [19]. More broadly, the impact of COVID-19 on stroke admissions and outcomes is also garnering increasing attention [20][21][22], with one recent study identifying higher cerebral venous thrombosis mortality in COVID-19 positive patients compared to COVID-19 negative patients [23].…”

The impact of a two-year long COVID-19 public health restriction program on mechanical thrombectomy outcomes in a stroke network

“…The impact of COVID-19 early on the pandemic on stroke has been well described with a significant decline in hospitalizations, mechanical thrombectomy procedures and intracranial hemorrhages admission volumes 1 , 2 , 3 , 4 , 5 , 6 , 7 . Advanced stroke therapy outcomes have been disparate in different countries, with worse outcomes reported mainly in middle- to lower-income populations or countries [ 8 , 9 , 10 , 11 , 12 , 13 ].…”