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

Authors
Nguyen, Thanh N
Qureshi, Muhammad M
Klein, Piers
Yamagami, Hiroshi
Mikulik, Robert
Czlonkowska, Anna
Abdalkader, Mohamad
Sedova, Petra
Sathya, Anvitha
Lo, Hannah C
UMass Chan Affiliations
Radiology
Document Type
Journal Article
Publication Date
2022-10-18
Keywords
COVID-19
acute stroke
intracranial hemorrhage
intravenous thrombolysis
ischemic stroke
mechanical thrombectomy

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Link to Full Text
https://doi.org/10.1212/wnl.0000000000201426
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 under NCT04934020.
Source
Nguyen TN, Qureshi MM, Klein P, Yamagami H, Mikulik R, Czlonkowska A, Abdalkader M, Sedova P, Sathya A, Lo HC, Mansour OY, Vanguru HR, Lesaine E, Tsivgoulis G, Loochtan AI, Demeestere J, Uchino K, Inoa V, Goyal N, Charidimou A, Siegler JE, Yaghi S, Aguiar de Sousa D, Mohammaden M, Haussen DC, Kristoffersen ES, Lereis VP, Scollo SD, Campbell BCV, Ma A, Thomas JO, Parsons MW, Singhal S, Slater LA, Martins RT, Enzinger C, Gattringer T, Rahman A, Bonnet T, Ligot N, De Raedt S, Lemmens R, Vanacker P, Vandervorst F, Conforto AB, Hidalgo RCT, de Oliveira Neves L, Martins RT, Mora Cuervo DL, Rebello LC, Santiago IB, Lameirinhas da Silva I, Sakelarova T, Kalpachki R, Alexiev F, Catanese L, Cora EA, Goyal M, Hill MD, Kelly ME, Khosravani H, Lavoie P, Peeling L, Pikula A, Rivera R, Chen HS, Chen Y, Huo X, Miao Z, Yang S, Bedekovic MR, Bralic M, Budincevic H, Corredor-Quintero AB, Lara-Sarabia OE, Cabal M, Tenora D, Fibrich P, Herzig R, Hlaváčová H, Hrabanovska E, Hlinovsky D, Jurak L, Kadlcikova J, Karpowicz I, Klecka L, Kovar M, Lauer D, Neumann J, Palouskova H, Reiser M, Rekova P, Rohan V, Skoda O, Škorňa M, Sobotková L, Sramek M, Zakova L, Christensen H, Drenck N, Iversen HK, Truelsen TC, Wienecke T, Sobh K, Ylikotila P, Alpay K, Strbian D, Bernady P, Casenave P, Dan M, Faucheux JM, Gentric JC, Magro E, Sabben C, Reiner P, Rouanet F, Bohmann FO, Boskamp S, Mbroh J, Nagel S, Nolte C, Ringleb PA, Rosenkranz M, Poli S, Thomalla G, Karapanayiotides T, Koutroulou I, Kargiotis O, Palaiodimou L, Barrientos Guerra JD, Huded V, Menon B, Nagendra S, Prajapati C, Sylaja PN, Krishna Pramana NA, Sani AF, Ghoreishi A, Farhoudi M, Hokmabadi ES, Raya TA, Kalmanovich SA, Ronen L, Sabetay SI, Acampa M, Adami A, Castellan L, Longoni M, Ornello R, Renieri L, Bigliani CR, Romoli M, Sacco S, Salmaggi A, Sangalli D, Zini A, Doijiri R, Fukuda H, Fujinaka T, Fujita K, Imamura H, Sakai N, Kanamaru T, Kimura N, Kono R, Miyake K, Sakaguchi M, Sakai K, Sonoda K, Todo K, Miyashita F, Tokuda N, Matsumaru Y, Matsumoto S, Ohara N, Shindo S, Takenobu Y, Yoshimoto T, Toyoda K, Uwatoko T, Yagita Y, Yamada T, Yamamoto N, Yamamoto R, Yazawa Y, Sugiura Y, Waweru PK, Baek JH, Lee SB, Seo KD, Sohn SI, Arsovska AA, Chan YC, Wan Zaidi WA, Jaafar AS, Gongora-Rivera F, Martinez-Marino M, Infante-Valenzuela A, Groppa S, Leahu P, Coutinho JM, Rinkel LA, Dippel DWJ, van Dam-Nolen DHK, Ranta A, Wu TY, Adebayo TT, Bello AH, Nwazor EO, Sunmonu TA, Wahab KW, Ronning OM, Sandset EC, Al Hashimi AM, Ahmad S, Rashid U, Rodriguez-Kadota L, Vences MÁ, Yalung PM, Hao Dy JS, Pineda-Franks MC, Co CO, Brola W, Debiec A, Dorobek M, Karlinski MA, Labuz-Roszak BM, Lasek-Bal A, Sienkiewicz-Jarosz H, Staszewski J, Sobolewski P, Wiacek M, Zielinska-Turek J, Araujo AP, Rocha M, Castro P, Cruz VT, Ferreira PV, Ferreira P, Nunes AP, Fonseca L, Marto JP, Pinho E Melo T, Rodrigues M, Silva ML, Dimitriade A, Falup-Pecurariu C, Hamid MA, Venketasubramanian N, Krastev G, Mako M, Ayo-Martin O, Hernández-Fernández F, Blasco J, Rodríguez-Vázquez A, Cruz-Culebras A, Moniche F, Montaner J, Perez-Sanchez S, García Sánchez MJ, Rodríguez MG, Jood K, Nordanstig A, Mazya MV, Moreira TTP, Bernava G, Beyeler M, Bolognese M, Carrera E, Dobrocky T, Karwacki GM, Keller E, Hsieh CY, Boonyakarnkul S, Churojana A, Aykac O, Ozdemir A, Bajrami A, Senadim S, Hussain SI, John S, Banerjee S, Kwan J, Krishnan K, Lenthall R, Matthews A, Wong K, Zhang L, Altschul D, Asif KS, Bahiru Z, Below K, Biller J, Ruland S, Chaudry SA, Chen M, Chebl A, Cibulka J, Cistrunk L, Clark J, Colasurdo M, Czap A, de Havenon A, D'Amato S, Dharmadhikari S, Grimmett KB, Dmytriw AA, Etherton MR, Ezepue C, Farooqui M, Feske SK, Fink L, Gasimova U, Guzik AK, Hakemi M, Hovingh M, Khan M, Jillela D, Kan PT, Khatri R, Khawaja AM, Khoury NN, Kiley NL, Kim BS, Kolikonda MK, Kuhn AL, Lara S, Linares G, Linfante I, Lukovits TG, Lycan S, Male SS, Maali L, Mancin J, Masoud H, Mohamed GA, Monteiro A, Nahab F, Nalleballe K, Gutierrez SO, Puri AS, Radaideh Y, Rahangdale RH, Rai A, Ramakrishnan P, Reddy AB, Rojas-Soto DM, Romero JR, Rost NS, Rothstein A, Omran SS, Sheth SA, Siddiqui AH, Starosciak AK, Tarlov NE, Taylor RA, Wang MJ, Wolfe J, Wong KH, Le HV, Nguyen QV, Pham TN, Nguyen TT, Phan HT, Ton MD, Fischer U, Michel P, Strambo D, Martins SO, Zaidat OO, Nogueira RG. Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: One-Year Follow-up. Neurology. 2022 Oct 18:10.1212/WNL.0000000000201426. doi: 10.1212/WNL.0000000000201426. Epub ahead of print. PMID: 36257718.
Permanent Link to this Item
http://hdl.handle.net/20.500.14038/51425
PubMed ID
36257718
Rights
© 2022 American Academy of Neurology.
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