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Interv Neuroradiol ; 27(1_suppl): 13-18, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1477216


The multisystem nature of coronavirus disease 2019 has become increasingly clear over the course of the pandemic. Both the neurological and vascular systems are affected, impacting acute stroke. This impact can be conceptualised as direct and indirect effects of the disease. The direct effects of coronavirus disease 2019 on stroke are thought to relate to receptor-mediated tissue invasion and the marked inflammatory response to the presence of the virus. These effects include coagulopathies, endotheliitis, systemic inflammation and atherosclerotic plaque instability, with possibly long-term cardiovascular effects. The indirect effects impact all aspects of stroke care delivery. These extend far beyond the direct effects of coronavirus disease 2019, and represent an essential focus for stroke systems of care. In this article, we detail the impact of coronavirus disease 2019 on acute stroke.

COVID-19 , Plaque, Atherosclerotic , Stroke , Humans , Pandemics , SARS-CoV-2
J Neurointerv Surg ; 12(10): 927-931, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-710047


BACKGROUND: Little is currently known about the effects of the coronavirus (COVID-19) pandemic on neurointerventional (NI) procedural volumes or its toll on physician wellness. METHODS: A 37-question online survey was designed and distributed to physician members of three NI physician organizations. RESULTS: A total of 151 individual survey responses were obtained. Reduced mechanical thrombectomy procedures compared with pre-pandemic were observed with 32% reporting a greater than 50% reduction in thrombectomy volumes. In concert with most (76%) reporting at least a 25% reduction in non-mechanical thrombectomy urgent NI procedures and a nearly unanimous (96%) cessation of non-urgent elective cases, 68% of physicians reported dramatic reductions (>50%) in overall NI procedural volume compared with pre-pandemic. Increased door-to-puncture times were reported by 79%. COVID-19-positive infections occurred in 1% of physician respondents: an additional 8% quarantined for suspected infection. Sixty-six percent of respondents reported increased career stress, 56% increased personal life/family stress, and 35% increased career burnout. Stress was significantly increased in physicians with COVID-positive family members (P<0.05). CONCLUSIONS: This is the first study designed to understand the effects of the COVID-19 pandemic on NI physician practices, case volumes, compensation, personal/family stresses, and work-related burnout. Future studies examining these factors following the resumption of elective cases and relaxing of social distancing measures will be necessary to better understand these phenomena.

Attitude of Health Personnel , Coronavirus Infections/epidemiology , Delivery of Health Care/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Neurosurgery/statistics & numerical data , Pandemics/statistics & numerical data , Physician's Role , Pneumonia, Viral/epidemiology , COVID-19 , Humans , Male , Surveys and Questionnaires , United States
J Neurointerv Surg ; 12(9): 831-835, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-626369


To assess the impact of COVID-19 on neurovascular research and deal with the challenges imposed by the pandemic. METHODS: A survey-based study focused on randomized controlled trials (RCTs) and single-arm studies for acute ischemic stroke and cerebral aneurysms was developed by a group of senior neurointerventionalists and sent to sites identified through the clinical trials website (, study sponsors, and physician investigators. RESULTS: The survey was sent to 101 institutions, with 65 responding (64%). Stroke RCTs were being conducted at 40 (62%) sites, aneurysm RCTs at 22 (34%) sites, stroke single-arm studies at 37 (57%) sites, and aneurysm single-arm studies at 43 (66%) sites. Following COVID-19, enrollment was suspended at 51 (78%) sites-completely at 21 (32%) and partially at 30 (46%) sites. Missed trial-related clinics and imaging follow-ups and protocol deviations were reported by 27 (42%), 24 (37%), and 27 (42%) sites, respectively. Negative reimbursements were reported at 17 (26%) sites. The majority of sites, 49 (75%), had put new trials on hold. Of the coordinators, 41 (63%) worked from home and 20 (31%) reported a personal financial impact. Remote consent was possible for some studies at 34 (52%) sites and for all studies at 5 (8%) sites. At sites with suspended trials (n=51), endovascular treatment without enrollment occurred at 31 (61%) sites for stroke and 23 (45%) sites for aneurysms. A total of 277 patients with acute ischemic stroke and 184 with cerebral aneurysms were treated without consideration for trial enrollment. CONCLUSION: Widespread disruption of neuroendovascular trials occurred because of COVID-19. As sites resume clinical research, steps to mitigate similar challenges in the future should be considered.

Betacoronavirus , Brain Ischemia/therapy , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Randomized Controlled Trials as Topic/methods , Stroke/therapy , Surveys and Questionnaires , Brain Ischemia/diagnosis , Brain Ischemia/epidemiology , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Endovascular Procedures/methods , Endovascular Procedures/trends , Female , Forecasting , Humans , Male , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Stroke/diagnosis , Stroke/epidemiology