Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

Thanh N Nguyen, Diogo C Haussen, Muhammad M Qureshi, Hiroshi Yamagami, Toshiyuki Fujinaka, Ossama Y Mansour, Mohamad Abdalkader, Michael Frankel, Zhongming Qiu, Allan Taylor, Pedro Lylyk, Omer F Eker, Laura Mechtouff, Michel Piotin, Fabricio Oliveira Lima, Francisco Mont'Alverne, Wazim Izzath, Nobuyuki Sakai, Mahmoud Mohammaden, Alhamza R Al-Bayati, Leonardo Renieri, Salvatore Mangiafico, David Ozretic, Vanessa Chalumeau, Saima Ahmad, Umair Rashid, Syed Irteza Hussain, Seby John, Emma Griffin, John Thornton, Jose Antonio Fiorot, Rodrigo Rivera, Nadia Hammami, Anna M Cervantes-Arslanian, Hormuzdiyar H Dasenbrock, Huynh Le Vu, Viet Quy Nguyen, Steven Hetts, Romain Bourcier, Romain Guile, Melanie Walker, Malveeka Sharma, Don Frei, Pascal Jabbour, Nabeel Herial, Fawaz Al-Mufti, Atilla Ozcan Ozdemir, Ozlem Aykac, Dheeraj Gandhi, Chandril Chugh, Charles Matouk, Pascale Lavoie, Randall Edgell, Andre Beer-Furlan, Michael Chen, Monika Killer-Oberpfalzer, Vitor Mendes Pereira, Patrick Nicholson, Vikram Huded, Nobuyuki Ohara, Daisuke Watanabe, Dong Hun Shin, Pedro Sc Magalhaes, Raghid Kikano, Santiago Ortega-Gutierrez, Mudassir Farooqui, Amal Abou-Hamden, Tatsuo Amano, Ryoo Yamamoto, Adrienne Weeks, Elena A Cora, Rotem Sivan-Hoffmann, Roberto Crosa, Markus Möhlenbruch, Simon Nagel, Hosam Al-Jehani, Sunil A Sheth, Victor S Lopez Rivera, James E Siegler, Achmad Fidaus Sani, Ajit S Puri, Anna Luisa Kuhn, Gianmarco Bernava, Paolo Machi, Daniel G Abud, Octavio M Pontes-Neto, Ajay K Wakhloo, Barbara Voetsch, Eytan Raz, Shadi Yaghi, Brijesh P Mehta, Naoto Kimura, Mamoru Murakami, Jin Soo Lee, Ji Man Hong, Robert Fahed, Gregory Walker, Eiji Hagashi, Steve M Cordina, Hong Gee Roh, Ken Wong, Juan F Arenillas, Mario Martinez-Galdamez, Jordi Blasco, Alejandro Rodriguez Vasquez, Luisa Fonseca, M Luis Silva, Teddy Y Wu, Simon John, Alex Brehm, Marios Psychogios, William J Mack, Matthew Tenser, Tatemi Todaka, Miki Fujimura, Roberta Novakovic, Jun Deguchi, Yuri Sugiura, Hiroshi Tokimura, Rakesh Khatri, Michael Kelly, Lissa Peeling, Yuichi Murayama, Hugh Stephen Winters, Johnny Wong, Mohamed Teleb, Jeremy Payne, Hiroki Fukuda, Kosuke Miyake, Junsuke Shimbo, Yusuke Sugimura, Masaaki Uno, Yohei Takenobu, Yuji Matsumaru, Satoshi Yamada, Ryuhei Kono, Takuya Kanamaru, Masafumi Morimoto, Junichi Iida, Vasu Saini, Dileep Yavagal, Saif Bushnaq, Wenguo Huang, Italo Linfante, Jawad Kirmani, David S Liebeskind, Viktor Szeder, Ruchir Shah, Thomas G Devlin, Lee Birnbaum, Jun Luo, Anchalee Churojana, Hesham E Masoud, Carlos Ynigo Lopez, Brendan Steinfort, Alice Ma, Ameer E Hassan, Amal Al Hashmi, Mollie McDermott, Maxim Mokin, Alex Chebl, Odysseas Kargiotis, Georgios Tsivgoulis, Jane G Morris, Clifford J Eskey, Jesse Thon, Leticia Rebello, Dorothea Altschul, Oriana Cornett, Varsha Singh, Jeyaraj Pandian, Anirudh Kulkarni, Pablo M Lavados, Veronica V Olavarria, Kenichi Todo, Yuki Yamamoto, Gisele Sampaio Silva, Serdar Geyik, Jasmine Johann, Sumeet Multani, Artem Kaliaev, Kazutaka Sonoda, Hiroyuki Hashimoto, Adel Alhazzani, David Y Chung, Stephan A Mayer, Johanna T Fifi, Michael D Hill, Hao Zhang, Zhengzhou Yuan, Xianjin Shang, Alicia C Castonguay, Rishi Gupta, Tudor G Jovin, Jean Raymond, Osama O Zaidat, Raul G Nogueira, SVIN COVID-19 Registry, the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO), Japanese Society of Vascular and Interventional Neurology Society (JVIN), Thanh N Nguyen, Diogo C Haussen, Muhammad M Qureshi, Hiroshi Yamagami, Toshiyuki Fujinaka, Ossama Y Mansour, Mohamad Abdalkader, Michael Frankel, Zhongming Qiu, Allan Taylor, Pedro Lylyk, Omer F Eker, Laura Mechtouff, Michel Piotin, Fabricio Oliveira Lima, Francisco Mont'Alverne, Wazim Izzath, Nobuyuki Sakai, Mahmoud Mohammaden, Alhamza R Al-Bayati, Leonardo Renieri, Salvatore Mangiafico, David Ozretic, Vanessa Chalumeau, Saima Ahmad, Umair Rashid, Syed Irteza Hussain, Seby John, Emma Griffin, John Thornton, Jose Antonio Fiorot, Rodrigo Rivera, Nadia Hammami, Anna M Cervantes-Arslanian, Hormuzdiyar H Dasenbrock, Huynh Le Vu, Viet Quy Nguyen, Steven Hetts, Romain Bourcier, Romain Guile, Melanie Walker, Malveeka Sharma, Don Frei, Pascal Jabbour, Nabeel Herial, Fawaz Al-Mufti, Atilla Ozcan Ozdemir, Ozlem Aykac, Dheeraj Gandhi, Chandril Chugh, Charles Matouk, Pascale Lavoie, Randall Edgell, Andre Beer-Furlan, Michael Chen, Monika Killer-Oberpfalzer, Vitor Mendes Pereira, Patrick Nicholson, Vikram Huded, Nobuyuki Ohara, Daisuke Watanabe, Dong Hun Shin, Pedro Sc Magalhaes, Raghid Kikano, Santiago Ortega-Gutierrez, Mudassir Farooqui, Amal Abou-Hamden, Tatsuo Amano, Ryoo Yamamoto, Adrienne Weeks, Elena A Cora, Rotem Sivan-Hoffmann, Roberto Crosa, Markus Möhlenbruch, Simon Nagel, Hosam Al-Jehani, Sunil A Sheth, Victor S Lopez Rivera, James E Siegler, Achmad Fidaus Sani, Ajit S Puri, Anna Luisa Kuhn, Gianmarco Bernava, Paolo Machi, Daniel G Abud, Octavio M Pontes-Neto, Ajay K Wakhloo, Barbara Voetsch, Eytan Raz, Shadi Yaghi, Brijesh P Mehta, Naoto Kimura, Mamoru Murakami, Jin Soo Lee, Ji Man Hong, Robert Fahed, Gregory Walker, Eiji Hagashi, Steve M Cordina, Hong Gee Roh, Ken Wong, Juan F Arenillas, Mario Martinez-Galdamez, Jordi Blasco, Alejandro Rodriguez Vasquez, Luisa Fonseca, M Luis Silva, Teddy Y Wu, Simon John, Alex Brehm, Marios Psychogios, William J Mack, Matthew Tenser, Tatemi Todaka, Miki Fujimura, Roberta Novakovic, Jun Deguchi, Yuri Sugiura, Hiroshi Tokimura, Rakesh Khatri, Michael Kelly, Lissa Peeling, Yuichi Murayama, Hugh Stephen Winters, Johnny Wong, Mohamed Teleb, Jeremy Payne, Hiroki Fukuda, Kosuke Miyake, Junsuke Shimbo, Yusuke Sugimura, Masaaki Uno, Yohei Takenobu, Yuji Matsumaru, Satoshi Yamada, Ryuhei Kono, Takuya Kanamaru, Masafumi Morimoto, Junichi Iida, Vasu Saini, Dileep Yavagal, Saif Bushnaq, Wenguo Huang, Italo Linfante, Jawad Kirmani, David S Liebeskind, Viktor Szeder, Ruchir Shah, Thomas G Devlin, Lee Birnbaum, Jun Luo, Anchalee Churojana, Hesham E Masoud, Carlos Ynigo Lopez, Brendan Steinfort, Alice Ma, Ameer E Hassan, Amal Al Hashmi, Mollie McDermott, Maxim Mokin, Alex Chebl, Odysseas Kargiotis, Georgios Tsivgoulis, Jane G Morris, Clifford J Eskey, Jesse Thon, Leticia Rebello, Dorothea Altschul, Oriana Cornett, Varsha Singh, Jeyaraj Pandian, Anirudh Kulkarni, Pablo M Lavados, Veronica V Olavarria, Kenichi Todo, Yuki Yamamoto, Gisele Sampaio Silva, Serdar Geyik, Jasmine Johann, Sumeet Multani, Artem Kaliaev, Kazutaka Sonoda, Hiroyuki Hashimoto, Adel Alhazzani, David Y Chung, Stephan A Mayer, Johanna T Fifi, Michael D Hill, Hao Zhang, Zhengzhou Yuan, Xianjin Shang, Alicia C Castonguay, Rishi Gupta, Tudor G Jovin, Jean Raymond, Osama O Zaidat, Raul G Nogueira, SVIN COVID-19 Registry, the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO), Japanese Society of Vascular and Interventional Neurology Society (JVIN)

Abstract

Background: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study's objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.

Methods: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation.

Findings: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p<0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p<0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile.

Interpretation: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.

Keywords: aneurysm; coil; haemorrhage; infection; subarachnoid.

Conflict of interest statement

Competing interests: TNN: PI CLEAR study (Medtronic). DCH: Stryker, Vesalio, Cerenovus consultant. AEH: consultant and speaker for Medtronic, Stryker, Microvention, Penumbra, Balt, Scientia, Genentech and GE Healthcare. PJ: Medtronic, Microvention, Balt, Cerenovus consultant. SO-G: Medtronic, Stryker consultant. DSL: Cerenovus, Genentech, Stryker, Medtronic consultant. TGJ: advisor/investor for Anaconda, Route92, FreeOx, and Blockade Medical; Medtronic grants, DAWN, AURORA PI (Stryker). WJM: consultant: Rebound Therapeutics, Viseon Imperative Care, Q’Apel, Stryker, Stream Biomedical, Spartan Micro; Investor: Cerebrotech, Endostream, Q’Apel, Viseon, Rebound, and Spartan Micro. RGN: Stryker; Cerenovus/Neuravi; Anaconda, Cerebrotech, Ceretrieve, Vesalio (Advisory Board); Imperative Care.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
*Peak of 1235 COVID-19 hospitalisations in the second week of February, predominantly from one hospital in Wuhan, China. SAH, subarachnoid haemorrhage.

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