Abstract 243: Impacts and Effects of COVID‐19 on Acute Ischemic Stroke Treatment in North America
Authors: Warrier Keshav R 
Published: March 2024

Introduction
The goal of this research project is to investigate the impacts and effects of the COVID‐19 pandemic on acute ischemic stroke treatment in North America. Acute ischemic stroke is the most common type of stroke in North America accounting for 87%, and occurs when blood traveling to the brain is blocked by a clot or other structural barrier (CDC, 2023). The most common way to treat these strokes is a mechanical thrombectomy. Stakeholders note that COVID‐19 exacerbated accessibility to treatment for ischemic and other strokes by increasing the door‐to‐needle time by up to 26% early in the pandemic through the barriers it created and/or intensified.

Methods
NCBI PudMed database searches, along with interviews with a diverse array of stakeholders from North America, were conducted to analyze the overarching effects COVID‐19 had on stroke treatment. The stakeholders interviewed during this project include neurologists from Boston, Kentucky, and Texas, as well as a neurologist and a physician from Mexico City.

Results
The barriers to stroke treatment discovered through this research project included staff shortages, a lack of patient awareness of stroke symptoms, and region‐specific geographic discrepancies increasing door‐to‐needle time. Among patients with an ischemic stroke, thrombectomy administration decreased by up to 25% in February 2020 compared to February 2019 (Zhao et al., 2020). This is likely due to an increasing focus on COVID‐19 treatment during the pandemic. In addition, hospital admissions related to stroke dropped by up to 46% in 2020 compared to 2019 (Sharma et al., 2020). Patients treated with thrombolysis during the pandemic were also required to wait upwards of 4 minutes longer for treatment, resulting in a small but significant delay in thrombolysis (Siegler et al., 2020). According to various stakeholders in North America, COVID‐19 also reportedly caused healthcare workers to become overworked and underpaid, creating pockets of highly competitive micro‐markets for workers. Regarding education, increased social isolation due to COVID‐19 shifted focus away from spreading stroke awareness, with more people being unfamiliar with the signs of stroke. Additionally, for populations relying on one stroke facility, hospital location and distance barriers delayed treatment time, increasing door‐to‐needle time in those regions, and dramatically decreasing the patient’s odds of survival. Stakeholders in urban areas note that door‐to‐needle time in major hospitals in the United States has decreased by about 3 minutes, and the administration of mechanical thrombectomies has increased by up to 25% following the pandemic.

Conclusion
The health issues caused by the incidence of stroke have amplified following the pandemic. This may be linked to healthcare worker shortages, wage gaps, geographical discrepancies, and decreased patient education. A continuing area of concern in the healthcare community is the lack of availability of thrombectomies and equipment required for effective stroke treatment in rural regions. Geographic and accessibility issues could be tackled by increasing the number of mobile stroke units and stroke centers in rural areas. Additionally, educational initiatives aimed at at‐risk populations and youth about the symptoms and types of strokes will help spread stroke awareness.