ABSTRACT
Background: Prior studies indicated a decrease in the incidences of subarachnoid hemorrhage (SAH) during the early stages of the COVID- 19 pandemic. We evaluated differences in the incidence, severity of SAH presentation, and ruptured aneurysm treatment modality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional study including 49 countries and 187 centers. We recorded volumes for: COVID-19 hospitalizations, SAH hospitalizations, Hunt-Hess Grade, coiling, clipping, and aneurysmal SAH (aSAH) in-hospital mortality. Diagnoses were identified by ICD-10 codes or stroke databases from January 2019 to May 2021. Results: Over the study period, there were 16,247 aSAH admissions, 344,491 COVID-19 admissions, 8,300 coiling and 4,240 aneurysmal clipping procedures. Declines were observed in aSAH admissions (-6.4% [95%CI -7,-5.8];p=0.0001) during the first year of the pandemic compared to the prior year, most pronounced in high-volume SAH and highvolume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentation of aSAH (mild: -5%[-5.9,-4.3], p=0.06;moderate: -8.3%[-10.2,-6.7], p=0.06) but no difference in higher SAH severity. The clipping rate remained unchanged (30.7% vs. 31.2%, p=0.58), whereas coiling increased (53.97%vs.56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%,p=0.12). Conclusion: During the first year of the pandemic, there was a decrease in aSAH admissions volume driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the coiling rate, but no change in clipping rate, nor change in aSAH in-hospital mortality.
ABSTRACT
Background and aims: COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with ischemic stroke (IS). We aimed to evaluate the safety and disability outcomes of revascularization treatments in patients with IS and COVID-19. Methods: Retrospective multicenter cohort study of consecutive IS patients receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March-2020 and June-2021, tested for SARSCoV- 2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). Study protocol was registered in ClinicalTrials.gov (NCT04895462). Results: Among 15128 revascularized patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT only, and 9280 (61.3%) EVT (+/- IVT). As shown in the Figure, treated patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH), symptomatic subarachnoid hemorrhage (sSAH), the combination thereof, higher mortality at 24 hours and 3 months, and worse 3-month modified Rankin score (mRS). Results for treatment subgroups were similar, except that in the IVT-only group only SICH, 3-month mRS and mortality were significantly increased. Conclusion: Ischemic stroke patients with COVID-19 showed higher rates of bleeding complications and worse clinical outcomes after acute revascularization treatments than contemporaneous non-COVID-19 treated patients. (Table Presented).
ABSTRACT
Introduction: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The objective was to examine whether subarachnoid hemorrhage(SAH) hospitalizations and ruptured aneurysm coiling interventions demonstrated similar declines. Methods: We conducted a global, retrospective, observational study across 6 continents, 37 countries, and 140 comprehensive stroke centers. Patients with diagnosis of SAH, ruptured aneurysm coiling interventions, COVID-19 were identified using ICD-10 codes or by prospectively maintained stroke databases. The 3-month cumulative volume, monthly volumes for SAH hospitalizations and ruptured aneurysm coiling procedures were compared for the period before (1- year and immediately before) and during the COVID-19 pandemic (March 1 to May 31, 2020). Results: There was a significant decline in SAH hospitalizations with 2,044 admissions in the 3 months immediately before and 1,585 admissions during the pandemic, representing a decline of 22.5% (95%CI, -24.3 to -20.7, p<0.0001). Embolization of ruptured aneurysms declined with 1,170 to 1,035 procedures, respectively, representing an 11.5%(95%CI, -13.5 to -9.8, p=0.002) drop. Hospitals with higher COVID-19 hospitalization burden demonstrated greater declines in SAH and ruptured aneurysm coiling compared to lower COVID-19 burden. A relative increase in coiling of ruptured aneurysms was noted in low coiling volume hospitals of 41.1% (95%CI, 32.3-50.6, p=0.008) despite a decrease in SAH admissions in this tertile. Conclusions: There was a global decrease in subarachnoid hemorrhage admissions and ruptured aneurysm embolizations during the COVID-19 pandemic. Among low-volume coiling SAH hospitals, there was an increase in the ruptured aneurysm coiling intervention. These findings in SAH are consistent with a global decrease in other emergencies such as stroke and myocardial infarction.