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

Thanh N Nguyen; Muhammad M Qureshi; Piers Klein; Hiroshi Yamagami; Robert Mikulik; Anna Czlonkowska; Mohamad Abdalkader; Petra Sedova; Anvitha Sathya; Hannah C Lo; Ossama Yassin Mansour; Husitha Reddy Vanguru; Emilie Lesaine; Georgios Tsivgoulis; Aaron I Loochtan; Jelle Demeestere; Ken Uchino; Violiza Inoa; Nitin Goyal; Andreas Charidimou; James E Siegler; Shadi Yaghi; Diana Aguiar de Sousa; Mahmoud Mohammaden; Diogo C Haussen; Espen Saxhaug Kristoffersen; Virginia Pujol Lereis; Sergio Daniel Scollo; Bruce C V Campbell; Alice Ma; James Orton Thomas; Mark W Parsons; Shaloo Singhal; Lee-Anne Slater; Rodrigo Tomazini Martins; Chris Enzinger; Thomas Gattringer; Aminur Rahman; Thomas Bonnet; Noemie Ligot; Sylvie De Raedt; Robin Lemmens; Peter Vanacker; Fenne Vandervorst; Adriana Bastos Conforto; Raquel C T Hidalgo; Luciana de Oliveira Neves; Rodrigo Targa Martins; Daissy Liliana Mora Cuervo; Leticia C Rebello; Troels Wienecke; Raul G Nogueira

doi:10.1212/WNL.0000000000201426

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

Thanh N Nguyen^*
, Muhammad M Qureshi
, Piers Klein
, Hiroshi Yamagami
, Robert Mikulik
, Anna Czlonkowska
, Mohamad Abdalkader
, Petra Sedova
, Anvitha Sathya
, Hannah C Lo
, Ossama Yassin Mansour
, Husitha Reddy Vanguru
, Emilie Lesaine
, Georgios Tsivgoulis
, Aaron I Loochtan
, Jelle Demeestere
, Ken Uchino
, Violiza Inoa
, Nitin Goyal
, Andreas Charidimou

James E Siegler, Shadi Yaghi, Diana Aguiar de Sousa, Mahmoud Mohammaden, Diogo C Haussen, Espen Saxhaug Kristoffersen, Virginia Pujol Lereis, Sergio Daniel Scollo, Bruce C V Campbell, Alice Ma, James Orton Thomas, Mark W Parsons, Shaloo Singhal, Lee-Anne Slater, Rodrigo Tomazini Martins, Chris Enzinger, Thomas Gattringer, Aminur Rahman, Thomas Bonnet, Noemie Ligot, Sylvie De Raedt, Robin Lemmens, Peter Vanacker, Fenne Vandervorst, Adriana Bastos Conforto, Raquel C T Hidalgo, Luciana de Oliveira Neves, Rodrigo Targa Martins, Daissy Liliana Mora Cuervo, Leticia C Rebello, Troels Wienecke, Raul G Nogueira

^*Corresponding author for this work

Neurology

Research output: Contribution to journal › Article › Research › peer-review

Abstract

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.

TRIAL REGISTRATION INFORMATION: This study is registered under NCT04934020.

Original language	English
Pages (from-to)	e408-e421
Journal	Neurology
Volume	100
Issue number	4
Early online date	18 Oct 2022
DOIs	https://doi.org/10.1212/WNL.0000000000201426
Publication status	Published - 24 Jan 2023

Keywords

Brain Ischemia/therapy
COVID-19/epidemiology
Follow-Up Studies
Humans
Intracranial Hemorrhages
Pandemics
Retrospective Studies
SARS-CoV-2
Stroke Volume
Stroke/epidemiology
Thrombectomy
Thrombolytic Therapy/methods
Treatment Outcome

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10.1212/WNL.0000000000201426

Cite this

Nguyen, T. N., Qureshi, M. M., Klein, P., Yamagami, H., Mikulik, R., Czlonkowska, A., Abdalkader, M., Sedova, P., Sathya, A., Lo, H. C., Mansour, O. Y., Vanguru, H. R., Lesaine, E., Tsivgoulis, G., Loochtan, A. I., Demeestere, J., Uchino, K., Inoa, V., Goyal, N., ... Nogueira, R. G. (2023). Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: A 1-Year Follow-up. Neurology, 100(4), e408-e421. https://doi.org/10.1212/WNL.0000000000201426

@article{247817b6428e44a582426d1583ea31e2,

title = "Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: A 1-Year Follow-up",

abstract = "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.TRIAL REGISTRATION INFORMATION: This study is registered under NCT04934020.",

keywords = "Brain Ischemia/therapy, COVID-19/epidemiology, Follow-Up Studies, Humans, Intracranial Hemorrhages, Pandemics, Retrospective Studies, SARS-CoV-2, Stroke Volume, Stroke/epidemiology, Thrombectomy, Thrombolytic Therapy/methods, Treatment Outcome",

author = "Nguyen, \{Thanh N\} and Qureshi, \{Muhammad M\} and Piers Klein and Hiroshi Yamagami and Robert Mikulik and Anna Czlonkowska and Mohamad Abdalkader and Petra Sedova and Anvitha Sathya and Lo, \{Hannah C\} and Mansour, \{Ossama Yassin\} and Vanguru, \{Husitha Reddy\} and Emilie Lesaine and Georgios Tsivgoulis and Loochtan, \{Aaron I\} and Jelle Demeestere and Ken Uchino and Violiza Inoa and Nitin Goyal and Andreas Charidimou and Siegler, \{James E\} and Shadi Yaghi and \{Aguiar de Sousa\}, Diana and Mahmoud Mohammaden and Haussen, \{Diogo C\} and Kristoffersen, \{Espen Saxhaug\} and Lereis, \{Virginia Pujol\} and Scollo, \{Sergio Daniel\} and Campbell, \{Bruce C V\} and Alice Ma and Thomas, \{James Orton\} and Parsons, \{Mark W\} and Shaloo Singhal and Lee-Anne Slater and Martins, \{Rodrigo Tomazini\} and Chris Enzinger and Thomas Gattringer and Aminur Rahman and Thomas Bonnet and Noemie Ligot and \{De Raedt\}, Sylvie and Robin Lemmens and Peter Vanacker and Fenne Vandervorst and Conforto, \{Adriana Bastos\} and Hidalgo, \{Raquel C T\} and \{de Oliveira Neves\}, Luciana and Martins, \{Rodrigo Targa\} and \{Mora Cuervo\}, \{Daissy Liliana\} and Rebello, \{Leticia C\} and Troels Wienecke and Nogueira, \{Raul G\}",

note = "{\textcopyright} 2022 American Academy of Neurology.",

year = "2023",

month = jan,

day = "24",

doi = "10.1212/WNL.0000000000201426",

language = "English",

volume = "100",

pages = "e408--e421",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "4",

}

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, L-A, 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, Wienecke, T & Nogueira, RG 2023, 'Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: A 1-Year Follow-up', Neurology, vol. 100, no. 4, pp. e408-e421. https://doi.org/10.1212/WNL.0000000000201426

TY - JOUR

T1 - Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events

T2 - A 1-Year Follow-up

AU - Nguyen, Thanh N

AU - Qureshi, Muhammad M

AU - Klein, Piers

AU - Yamagami, Hiroshi

AU - Mikulik, Robert

AU - Czlonkowska, Anna

AU - Abdalkader, Mohamad

AU - Sedova, Petra

AU - Sathya, Anvitha

AU - Lo, Hannah C

AU - Mansour, Ossama Yassin

AU - Vanguru, Husitha Reddy

AU - Lesaine, Emilie

AU - Tsivgoulis, Georgios

AU - Loochtan, Aaron I

AU - Demeestere, Jelle

AU - Uchino, Ken

AU - Inoa, Violiza

AU - Goyal, Nitin

AU - Charidimou, Andreas

AU - Siegler, James E

AU - Yaghi, Shadi

AU - Aguiar de Sousa, Diana

AU - Mohammaden, Mahmoud

AU - Haussen, Diogo C

AU - Kristoffersen, Espen Saxhaug

AU - Lereis, Virginia Pujol

AU - Scollo, Sergio Daniel

AU - Campbell, Bruce C V

AU - Ma, Alice

AU - Thomas, James Orton

AU - Parsons, Mark W

AU - Singhal, Shaloo

AU - Slater, Lee-Anne

AU - Martins, Rodrigo Tomazini

AU - Enzinger, Chris

AU - Gattringer, Thomas

AU - Rahman, Aminur

AU - Bonnet, Thomas

AU - Ligot, Noemie

AU - De Raedt, Sylvie

AU - Lemmens, Robin

AU - Vanacker, Peter

AU - Vandervorst, Fenne

AU - Conforto, Adriana Bastos

AU - Hidalgo, Raquel C T

AU - de Oliveira Neves, Luciana

AU - Martins, Rodrigo Targa

AU - Mora Cuervo, Daissy Liliana

AU - Rebello, Leticia C

AU - Wienecke, Troels

AU - Nogueira, Raul G

PY - 2023/1/24

Y1 - 2023/1/24

N2 - 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.TRIAL REGISTRATION INFORMATION: This study is registered under NCT04934020.

AB - 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.TRIAL REGISTRATION INFORMATION: This study is registered under NCT04934020.

KW - Brain Ischemia/therapy

KW - COVID-19/epidemiology

KW - Follow-Up Studies

KW - Humans

KW - Intracranial Hemorrhages

KW - Pandemics

KW - Retrospective Studies

KW - SARS-CoV-2

KW - Stroke Volume

KW - Stroke/epidemiology

KW - Thrombectomy

KW - Thrombolytic Therapy/methods

KW - Treatment Outcome

U2 - 10.1212/WNL.0000000000201426

DO - 10.1212/WNL.0000000000201426

M3 - Article

C2 - 36257718

SN - 0028-3878

VL - 100

SP - e408-e421

JO - Neurology

JF - Neurology

IS - 4

ER -

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

Abstract

Keywords

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