Global Impact of COVID-19 on Cerebrovascular Events

Highlights

Although patterns of stroke admissions have been observed at each center during the first year of the COVID-19 pandemic, overall trends are not well characterized. This multicenter international registry study investigated trends in admissions for ischemic and hemorrhagic stroke, as well as the utilization of hyperacute treatments for ischemic stroke. The authors observed a decrease in the number of admissions for ischemic (approximately 7%; p < 0.0001) and hemorrhagic stroke (4.8%; p < 0.0001) in the first year of the pandemic compared to the previous year, and the decline was more pronounced in high-volume centers (P < 0.0001). Although a decrease in the rate of thrombolytic administration was observed in the first year of the pandemic compared to the previous year, the rate of mechanical thrombectomy remained stable.
This study confirms the anecdotal observation of the decrease in the number of hospital admissions for ischemic and hemorrhagic stroke at the beginning of the COVID-19 pandemic. Patients with large vessel occlusion still presented to the hospital, suggesting that the decrease was not seen in patients with severe stroke. Stroke was common among hospitalized patients with SARS-CoV-2 infection.

Background

Decreases in admission volumes for stroke, intravenous thrombolysis, and mechanical thrombectomy were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the long-term effect of the pandemic on stroke volumes over the course of a year and during the second wave of the pandemic.

We sought to measure the impact of the COVID-19 pandemic on admission volumes for stroke, intracranial hemorrhage (ICH), intravenous thrombolysis (IVT), and mechanical thrombectomy over a one-year period at the start of the pandemic (March 1, 2008). 2020, to February 28, 2021) compared to the immediately previous year (March 1, 2019 to February 29, 2020).

Methods

We conducted a retrospective longitudinal 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 admissions for stroke in the immediately preceding year compared with 138,453 admissions during the pandemic year, representing a decrease of 7% (95% confidence interval [95% CI 7.1, 6.9]). ; p<0.0001). ICH volumes decreased 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 decreases were observed in high-volume centers compared to low-volume centers (all p<0.0001). There were no significant changes 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], 5656/195539) of all stroke hospitalizations.

Discussion

There was an overall decrease and shift to lower-volume centers in stroke admission volumes, ICH volumes, and IVT volumes during the first year of the COVID-19 pandemic compared to the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in stroke care of greater disease severity during the first year of the pandemic.

Global Impact of COVID-19 on Cerebrovascular Events

The COVID-19 pandemic initially led to a decrease in hospital admissions for ischemic and hemorrhagic stroke, indicating complex effects on cerebrovascular health.