Global impact of COVID-19 on stroke care
Authors: Nogueira Raul G. , Abdalkader Mohamad , Qureshi Muhammed M. , Frankel Michael R. , Mansour Ossama Yassin , Yamagami Hiroshi , Qiu Zhongming , Farhoudi Mehdi , Siegler James E. , Yaghi Shadi , Raz Eytan , Sakai Nobuyuki , Ohara Nobuyuki , Piotin Michel , Mechtouff Laura , Eker Omer , Chalumeau Vanessa , Kleinig Timothy J. , Pop Raoul , Liu Jianmin , Winters Hugh S. , Shang Xianjin , Vasquez Alejandro Rodriguez , Blasco Jordi , Arenillas Juan F. , Martinez-Galdamez Mario , Brehm Alex , Psychogios Marios-Nikos , Lylyk Pedro , Haussen Diogo C. , Al-Bayati Alhamza R. , Mohammaden Mahmoud H. , Fonseca Luísa , Luís Silva M , Montalverne Francisco , Renieri Leonardo , Mangiafico Salvatore , Fischer Urs , Gralla Jan , Frei ,Donald , Chugh Chandril , Mehta Brijesh P. , Nagel Simon , Mohlenbruch Markus , Ortega-Gutierrez Santiago , Farooqui Mudassir , Hassan Ameer E. , Taylor Allan , Lapergue Bertrand , Consoli Arturo , Campbell Bruce CV , Sharma Malveeka , Walker Melanie , Van Horn Noel , Fiehler Jens , Nguyen Huy Thang , Nguyen Quoc T. , Watanabe Daisuke , Zhang Hao , Le Huynh V. , Nguyen Viet Q. , Shah Ruchir , Devlin Thomas , Khandelwal Priyank , Linfante Italo , Izzath Wazim , Lavados Pablo M. , Olavarría Veronica V. , Sampaio Silva Gisele , de Carvalho Sousa Anna Verena , Kirmani Jawad , Bendszus Martin , Amano Tatsuo , Yamamoto Ryoo , Doijiri Ryosuke , Tokuda Naoki , Yamada Takehiro , Terasaki Tadashi , Yazawa Yukako , Morris Jane G. , Griffin Emma , Thornton John , Lavoie Pascale , Matouk Charles , Hill Michael D. , Demchuk Andrew M. , Killer-Oberpfalzer Monika , Nahab Fadi , Altschul Dorothea , Ramos-Pachón Anna , Pérez de la Ossa Natalia , Kikano Raghid , Boisseau William , Walker Gregory , Cordina Steve M. , Puri Ajit , Luisa Kuhn Anna , Gandhi Dheeraj , Ramakrishnan Pankajavalli , Novakovic-White Roberta , Chebl Alex , Kargiotis Odysseas , Czap Alexandra , Zha Alicia , Masoud Hesham E. , Lopez Carlos , Ozretic David , Al-Mufti Fawaz , Zie Wenjie , Duan Zhenhui , Yuan Zhengzhou , Huang Wenguo , Hao Yonggang , Luo Jun , Kalousek Vladimir , Bourcier Romain , Guile Romain , Hetts Steven , Al-Jehani Hosam M. , AlHazzani Adel , Sadeghi-Hokmabadi Elyar , Teleb Mohamed , Payne Jeremy , Lee Jin Soo , Hong Ji Man , Sohn Sung-Il , Hwang Yang-ha , Shin Dong Hoon , Roh Hong Gee , Edgell Randy , Khatri Rakesh , Smith Ainsley , Malik Amer , Liebeskind David , Herial Nabeel , Jabbour Pascal , Magalhaes Pedro , Ozdemir Atilla Ozcan , Aykac Ozlem , Uwatoko Takeshi , Dembo Tomohisa , Shimizu Hisao , Sugiura Yuri , Miyashita Fumio , Fukuda Hiroki , Miyake Kosuke , Shimbo Junsuke , Sugimura Yusuke , Beer-Furlan Andre , Joshi Krishna , Catanese Luciana , Abud Daniel Giansante , Neto Octavio Giansante , Mehrpour Masoud , Al Hashmi Amal , Saqqur Mahar , Mostafa Abdulrahman , Fifi Johanna T. , Hussain Syed , John Seby , Gupta Rishi , Sivan-Hoffmann Rotem , Reznik Anna , Sani Achmad Fidaus , Geyik Serdar , Akıl Eşref , Churojana Anchalee , Ghoreishi Abdoreza , Saadatnia Mohammad , Sharifipour Ehsan , Ma Alice , Faulder Ken , Wu Teddy , Leung Lester , Malek Adel , Voetsch Barbara , Wakhloo Ajay , Rivera Rodrigo , Barrientos Iman Danny Moises , Pikula Aleksandra , Lioutas Vasileios-Arsenios , Thomalla Gotz , Birnbaum Lee , Machi Paolo , Bernava Gianmarco , McDermott Mollie , Kleindorfer Dawn , Wong Ken , Patterson Mary S. , Fiorot Jose Antonio , Huded Vikram , Mack William , Tenser Matthew , Eskey Clifford , Multani Sumeet , Kelly Michael , Janardhan Vallabh , Cornett Oriana , Singh Varsha , Murayama Yuichi , Mokin Maxim , Yang Pengfei , Zhang Xiaoxi , Yin Congguo , Han Hongxing , Peng Ya , Chen Wenhuo , Crosa Roberto , Frudit Michel Eli , Pandian Jeyaraj D. , Kulkarni Anirudh , Yagita Yoshiki , Takenobu Yohei , Matsumaru Yuji , Yamada Satoshi , Kono Ryuhei , Kanamaru Takuya , Yamazaki Hidekazu , Sakaguchi Manabu , Todo Kenichi , Yamamoto Nobuaki , Sonoda Kazutaka , Yoshida Tomoko , Hashimoto Hiroyuki , Nakahara Ichiro , Cora Elena , Volders David , Ducroux Celina , Shoamanesh Ashkan , Ospel Johanna , Kaliaev Artem , Ahmed Saima , Rashid Umair , Rebello Leticia C. , Pereira Vitor Mendes , Fahed Robert , Chen Michael , Sheth Sunil A , Palaiodimou Lina , Tsivgoulis Georgios , Chandra Ronil , Koyfman Feliks , Leung Thomas , Khosravani Houman , Dharmadhikari Sushrut , Frisullo Giovanni , Calabresi Paolo , Tsiskaridze Alexander , Lobjanidze Nino , Grigoryan Mikayel , Czlonkowska Anna , de Sousa Diana Aguiar , Demeestere Jelle , Liang Conrad , Sangha Navdeep , Lutsep Helmi L. , Ayo-Martín Óscar , Cruz-Culebras Antonio , Tran Anh D. , Young Chang Y. , Cordonnier Charlotte , Caparros Francois , De Lecinana Maria Alonso , Fuentes Blanca , Yavagal Dileep , Jovin Tudor , Spelle Laurent , Moret Jacques , Khatri Pooja , Zaidat Osama , Raymond Jean , Martins Sheila , Nguyen Thanh 
Published: January 2021

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.