Global impact of COVID-19 on stroke care

Raul G Nogueira, Mohamad Abdalkader, Muhammed M Qureshi, Michael R Frankel, Ossama Yassin Mansour, Hiroshi Yamagami, Zhongming Qiu, Mehdi Farhoudi, James E Siegler, Shadi Yaghi, Eytan Raz, Nobuyuki Sakai, Nobuyuki Ohara, Michel Piotin, Laura Mechtouff, Omer Eker, Vanessa Chalumeau, Timothy J Kleinig, Raoul Pop, Jianmin Liu, Hugh S Winters, Xianjin Shang, Alejandro Rodriguez Vasquez, Jordi Blasco, Juan F Arenillas, Mario Martinez-Galdamez, Alex Brehm, Marios-Nikos Psychogios, Pedro Lylyk, Diogo C Haussen, Alhamza R Al-Bayati, Mahmoud H Mohammaden, Luísa Fonseca, M Luís Silva, Francisco Montalverne, Leonardo Renieri, Salvatore Mangiafico, Urs Fischer, Jan Gralla, Donald Frei, Chandril Chugh, Brijesh P Mehta, Simon Nagel, Markus Mohlenbruch, Santiago Ortega-Gutierrez, Mudassir Farooqui, Ameer E Hassan, Allan Taylor, Bertrand Lapergue, Arturo Consoli, Bruce Cv Campbell, Malveeka Sharma, Melanie Walker, Noel Van Horn, Jens Fiehler, Huy Thang Nguyen, Quoc T Nguyen, Daisuke Watanabe, Hao Zhang, Huynh V Le, Viet Q Nguyen, Ruchir Shah, Thomas Devlin, Priyank Khandelwal, Italo Linfante, Wazim Izzath, Pablo M Lavados, Veronica V Olavarría, Gisele Sampaio Silva, Anna Verena de Carvalho Sousa, Jawad Kirmani, Martin Bendszus, Tatsuo Amano, Ryoo Yamamoto, Ryosuke Doijiri, Naoki Tokuda, Takehiro Yamada, Tadashi Terasaki, Yukako Yazawa, Jane G Morris, Emma Griffin, John Thornton, Pascale Lavoie, Charles Matouk, Michael D Hill, Andrew M Demchuk, Monika Killer-Oberpfalzer, Fadi Nahab, Dorothea Altschul, Anna Ramos-Pachón, Natalia Pérez de la Ossa, Raghid Kikano, William Boisseau, Gregory Walker, Steve M Cordina, Ajit Puri, Anna Luisa Kuhn, Dheeraj Gandhi, Pankajavalli Ramakrishnan, Roberta Novakovic-White, Alex Chebl, Odysseas Kargiotis, Alexandra Czap, Alicia Zha, Hesham E Masoud, Carlos Lopez, David Ozretic, Fawaz Al-Mufti, Wenjie Zie, Zhenhui Duan, Zhengzhou Yuan, Wenguo Huang, Yonggang Hao, Jun Luo, Vladimir Kalousek, Romain Bourcier, Romain Guile, Steven Hetts, Hosam M Al-Jehani, Adel AlHazzani, Elyar Sadeghi-Hokmabadi, Mohamed Teleb, Jeremy Payne, Jin Soo Lee, Ji Man Hong, Sung-Il Sohn, Yang-Ha Hwang, Dong Hoon Shin, Hong Gee Roh, Randy Edgell, Rakesh Khatri, Ainsley Smith, Amer Malik, David Liebeskind, Nabeel Herial, Pascal Jabbour, Pedro Magalhaes, Atilla Ozcan Ozdemir, Ozlem Aykac, Takeshi Uwatoko, Tomohisa Dembo, Hisao Shimizu, Yuri Sugiura, Fumio Miyashita, Hiroki Fukuda, Kosuke Miyake, Junsuke Shimbo, Yusuke Sugimura, Andre Beer-Furlan, Krishna Joshi, Luciana Catanese, Daniel Giansante Abud, Octavio Giansante Neto, Masoud Mehrpour, Amal Al Hashmi, Mahar Saqqur, Abdulrahman Mostafa, Johanna T Fifi, Syed Hussain, Seby John, Rishi Gupta, Rotem Sivan-Hoffmann, Anna Reznik, Achmad Fidaus Sani, Serdar Geyik, Eşref Akıl, Anchalee Churojana, Abdoreza Ghoreishi, Mohammad Saadatnia, Ehsan Sharifipour, Alice Ma, Ken Faulder, Teddy Wu, Lester Leung, Adel Malek, Barbara Voetsch, Ajay Wakhloo, Rodrigo Rivera, Danny Moises Barrientos Iman, Aleksandra Pikula, Vasileios-Arsenios Lioutas, Gotz Thomalla, Lee Birnbaum, Paolo Machi, Gianmarco Bernava, Mollie McDermott, Dawn Kleindorfer, Ken Wong, Mary S Patterson, Jose Antonio Fiorot Jr, Vikram Huded, William Mack, Matthew Tenser, Clifford Eskey, Sumeet Multani, Michael Kelly, Vallabh Janardhan, Oriana Cornett, Varsha Singh, Yuichi Murayama, Maxim Mokin, Pengfei Yang, Xiaoxi Zhang, Congguo Yin, Hongxing Han, Ya Peng, Wenhuo Chen, Roberto Crosa, Michel Eli Frudit, Jeyaraj D Pandian, Anirudh Kulkarni, Yoshiki Yagita, Yohei Takenobu, Yuji Matsumaru, Satoshi Yamada, Ryuhei Kono, Takuya Kanamaru, Hidekazu Yamazaki, Manabu Sakaguchi, Kenichi Todo, Nobuaki Yamamoto, Kazutaka Sonoda, Tomoko Yoshida, Hiroyuki Hashimoto, Ichiro Nakahara, Elena Cora, David Volders, Celina Ducroux, Ashkan Shoamanesh, Johanna Ospel, Artem Kaliaev, Saima Ahmed, Umair Rashid, Leticia C Rebello, Vitor Mendes Pereira, Robert Fahed, Michael Chen, Sunil A Sheth, Lina Palaiodimou, Georgios Tsivgoulis, Ronil Chandra, Feliks Koyfman, Thomas Leung, Houman Khosravani, Sushrut Dharmadhikari, Giovanni Frisullo, Paolo Calabresi, Alexander Tsiskaridze, Nino Lobjanidze, Mikayel Grigoryan, Anna Czlonkowska, Diana Aguiar de Sousa, Jelle Demeestere, Conrad Liang, Navdeep Sangha, Helmi L Lutsep, Óscar Ayo-Martín, Antonio Cruz-Culebras, Anh D Tran, Chang Y Young, Charlotte Cordonnier, Francois Caparros, Maria Alonso De Lecinana, Blanca Fuentes, Dileep Yavagal, Tudor Jovin, Laurent Spelle, Jacques Moret, Pooja Khatri, Osama Zaidat, Jean Raymond, Sheila Martins, Thanh Nguyen, Raul G Nogueira, Mohamad Abdalkader, Muhammed M Qureshi, Michael R Frankel, Ossama Yassin Mansour, Hiroshi Yamagami, Zhongming Qiu, Mehdi Farhoudi, James E Siegler, Shadi Yaghi, Eytan Raz, Nobuyuki Sakai, Nobuyuki Ohara, Michel Piotin, Laura Mechtouff, Omer Eker, Vanessa Chalumeau, Timothy J Kleinig, Raoul Pop, Jianmin Liu, Hugh S Winters, Xianjin Shang, Alejandro Rodriguez Vasquez, Jordi Blasco, Juan F Arenillas, Mario Martinez-Galdamez, Alex Brehm, Marios-Nikos Psychogios, Pedro Lylyk, Diogo C Haussen, Alhamza R Al-Bayati, Mahmoud H Mohammaden, Luísa Fonseca, M Luís Silva, Francisco Montalverne, Leonardo Renieri, Salvatore Mangiafico, Urs Fischer, Jan Gralla, Donald Frei, Chandril Chugh, Brijesh P Mehta, Simon Nagel, Markus Mohlenbruch, Santiago Ortega-Gutierrez, Mudassir Farooqui, Ameer E Hassan, Allan Taylor, Bertrand Lapergue, Arturo Consoli, Bruce Cv Campbell, Malveeka Sharma, Melanie Walker, Noel Van Horn, Jens Fiehler, Huy Thang Nguyen, Quoc T Nguyen, Daisuke Watanabe, Hao Zhang, Huynh V Le, Viet Q Nguyen, Ruchir Shah, Thomas Devlin, Priyank Khandelwal, Italo Linfante, Wazim Izzath, Pablo M Lavados, Veronica V Olavarría, Gisele Sampaio Silva, Anna Verena de Carvalho Sousa, Jawad Kirmani, Martin Bendszus, Tatsuo Amano, Ryoo Yamamoto, Ryosuke Doijiri, Naoki Tokuda, Takehiro Yamada, Tadashi Terasaki, Yukako Yazawa, Jane G Morris, Emma Griffin, John Thornton, Pascale Lavoie, Charles Matouk, Michael D Hill, Andrew M Demchuk, Monika Killer-Oberpfalzer, Fadi Nahab, Dorothea Altschul, Anna Ramos-Pachón, Natalia Pérez de la Ossa, Raghid Kikano, William Boisseau, Gregory Walker, Steve M Cordina, Ajit Puri, Anna Luisa Kuhn, Dheeraj Gandhi, Pankajavalli Ramakrishnan, Roberta Novakovic-White, Alex Chebl, Odysseas Kargiotis, Alexandra Czap, Alicia Zha, Hesham E Masoud, Carlos Lopez, David Ozretic, Fawaz Al-Mufti, Wenjie Zie, Zhenhui Duan, Zhengzhou Yuan, Wenguo Huang, Yonggang Hao, Jun Luo, Vladimir Kalousek, Romain Bourcier, Romain Guile, Steven Hetts, Hosam M Al-Jehani, Adel AlHazzani, Elyar Sadeghi-Hokmabadi, Mohamed Teleb, Jeremy Payne, Jin Soo Lee, Ji Man Hong, Sung-Il Sohn, Yang-Ha Hwang, Dong Hoon Shin, Hong Gee Roh, Randy Edgell, Rakesh Khatri, Ainsley Smith, Amer Malik, David Liebeskind, Nabeel Herial, Pascal Jabbour, Pedro Magalhaes, Atilla Ozcan Ozdemir, Ozlem Aykac, Takeshi Uwatoko, Tomohisa Dembo, Hisao Shimizu, Yuri Sugiura, Fumio Miyashita, Hiroki Fukuda, Kosuke Miyake, Junsuke Shimbo, Yusuke Sugimura, Andre Beer-Furlan, Krishna Joshi, Luciana Catanese, Daniel Giansante Abud, Octavio Giansante Neto, Masoud Mehrpour, Amal Al Hashmi, Mahar Saqqur, Abdulrahman Mostafa, Johanna T Fifi, Syed Hussain, Seby John, Rishi Gupta, Rotem Sivan-Hoffmann, Anna Reznik, Achmad Fidaus Sani, Serdar Geyik, Eşref Akıl, Anchalee Churojana, Abdoreza Ghoreishi, Mohammad Saadatnia, Ehsan Sharifipour, Alice Ma, Ken Faulder, Teddy Wu, Lester Leung, Adel Malek, Barbara Voetsch, Ajay Wakhloo, Rodrigo Rivera, Danny Moises Barrientos Iman, Aleksandra Pikula, Vasileios-Arsenios Lioutas, Gotz Thomalla, Lee Birnbaum, Paolo Machi, Gianmarco Bernava, Mollie McDermott, Dawn Kleindorfer, Ken Wong, Mary S Patterson, Jose Antonio Fiorot Jr, Vikram Huded, William Mack, Matthew Tenser, Clifford Eskey, Sumeet Multani, Michael Kelly, Vallabh Janardhan, Oriana Cornett, Varsha Singh, Yuichi Murayama, Maxim Mokin, Pengfei Yang, Xiaoxi Zhang, Congguo Yin, Hongxing Han, Ya Peng, Wenhuo Chen, Roberto Crosa, Michel Eli Frudit, Jeyaraj D Pandian, Anirudh Kulkarni, Yoshiki Yagita, Yohei Takenobu, Yuji Matsumaru, Satoshi Yamada, Ryuhei Kono, Takuya Kanamaru, Hidekazu Yamazaki, Manabu Sakaguchi, Kenichi Todo, Nobuaki Yamamoto, Kazutaka Sonoda, Tomoko Yoshida, Hiroyuki Hashimoto, Ichiro Nakahara, Elena Cora, David Volders, Celina Ducroux, Ashkan Shoamanesh, Johanna Ospel, Artem Kaliaev, Saima Ahmed, Umair Rashid, Leticia C Rebello, Vitor Mendes Pereira, Robert Fahed, Michael Chen, Sunil A Sheth, Lina Palaiodimou, Georgios Tsivgoulis, Ronil Chandra, Feliks Koyfman, Thomas Leung, Houman Khosravani, Sushrut Dharmadhikari, Giovanni Frisullo, Paolo Calabresi, Alexander Tsiskaridze, Nino Lobjanidze, Mikayel Grigoryan, Anna Czlonkowska, Diana Aguiar de Sousa, Jelle Demeestere, Conrad Liang, Navdeep Sangha, Helmi L Lutsep, Óscar Ayo-Martín, Antonio Cruz-Culebras, Anh D Tran, Chang Y Young, Charlotte Cordonnier, Francois Caparros, Maria Alonso De Lecinana, Blanca Fuentes, Dileep Yavagal, Tudor Jovin, Laurent Spelle, Jacques Moret, Pooja Khatri, Osama Zaidat, Jean Raymond, Sheila Martins, Thanh Nguyen

Abstract

Background: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide.

Aims: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March-31 May 2020) compared with two control three-month periods (immediately preceding and one year prior).

Methods: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers.

Results: The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, -19.7 to -18.7), 11.5% (95%CI, -12.6 to -10.6), and 12.7% (95%CI, -13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (-20.5%) had greater declines in mechanical thrombectomy volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p < 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions.

Conclusion: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes.

Keywords: COVID-19; acute ischemic stroke; epidemiology; intracranial hemorrhage; mechanical thrombectomy; stroke care.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Weekly volume of stroke admissions (ischemic and hemorrhagic) and COVID-19 hospitalizations volumes. *Peak of 1235 COVID hospitalizations in the second week of February, predominantly from one hospital in Wuhan, China.
Figure 2.
Figure 2.
Weekly volume of mechanical thrombectomy and COVID-19 hospitalizations. *Peak of 1235 COVID hospitalizations in the second week of February, predominantly from one hospital in Wuhan, China.

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Source: PubMed

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