Observational Study

. 2021 Jul;16(5):573-584.

doi: 10.1177/1747493021991652. Epub 2021 Mar 29.

Global impact of COVID-19 on stroke care

Raul G Nogueira¹, Mohamad Abdalkader², Muhammed M Qureshi³, Michael R Frankel¹, Ossama Yassin Mansour⁴, Hiroshi Yamagami⁵, Zhongming Qiu⁶, Mehdi Farhoudi⁷, James E Siegler⁸, Shadi Yaghi⁹, Eytan Raz¹⁰, Nobuyuki Sakai¹¹, Nobuyuki Ohara¹², Michel Piotin¹³, Laura Mechtouff¹⁴, Omer Eker¹⁵, Vanessa Chalumeau¹⁶, Timothy J Kleinig¹⁷, Raoul Pop¹⁸, Jianmin Liu¹⁹, Hugh S Winters²⁰, Xianjin Shang²¹, Alejandro Rodriguez Vasquez²², Jordi Blasco²³, Juan F Arenillas²⁴, Mario Martinez-Galdamez²⁵, Alex Brehm²⁶, Marios-Nikos Psychogios²⁶, Pedro Lylyk²⁷, Diogo C Haussen¹, Alhamza R Al-Bayati¹, Mahmoud H Mohammaden¹, Luísa Fonseca²⁸, M Luís Silva²⁹, Francisco Montalverne³⁰, Leonardo Renieri³¹, Salvatore Mangiafico³¹, Urs Fischer³², Jan Gralla³³, Donald Frei³⁴, Chandril Chugh³⁵, Brijesh P Mehta³⁶, Simon Nagel³⁷, Markus Mohlenbruch³⁸, Santiago Ortega-Gutierrez³⁹, Mudassir Farooqui³⁹, Ameer E Hassan⁴⁰, Allan Taylor⁴¹, Bertrand Lapergue⁴², Arturo Consoli⁴³, Bruce Cv Campbell⁴⁴, Malveeka Sharma⁴⁵, Melanie Walker⁴⁶, Noel Van Horn⁴⁷, Jens Fiehler⁴⁷, Huy Thang Nguyen⁴⁸, Quoc T Nguyen⁴⁸, Daisuke Watanabe⁴⁹, Hao Zhang⁵⁰, Huynh V Le⁵¹, Viet Q Nguyen⁵¹, Ruchir Shah⁵², Thomas Devlin⁵², Priyank Khandelwal⁵³, Italo Linfante⁵⁴, Wazim Izzath⁵⁵, Pablo M Lavados⁵⁶, Veronica V Olavarría⁵⁶, Gisele Sampaio Silva⁵⁷, Anna Verena de Carvalho Sousa⁵⁸, Jawad Kirmani⁵⁹, Martin Bendszus³⁸, Tatsuo Amano⁶⁰, Ryoo Yamamoto⁶¹, Ryosuke Doijiri⁶², Naoki Tokuda⁶³, Takehiro Yamada⁶⁴, Tadashi Terasaki⁶⁵, Yukako Yazawa⁶⁶, Jane G Morris⁶⁷, Emma Griffin⁶⁸, John Thornton⁶⁸, Pascale Lavoie⁶⁹, Charles Matouk⁷⁰, Michael D Hill⁷¹, Andrew M Demchuk⁷¹, Monika Killer-Oberpfalzer⁷², Fadi Nahab⁷³, Dorothea Altschul⁷⁴, Anna Ramos-Pachón⁷⁵, Natalia Pérez de la Ossa⁷⁵, Raghid Kikano⁷⁶, William Boisseau⁷⁷, Gregory Walker⁷⁸, Steve M Cordina⁷⁹, Ajit Puri⁸⁰, Anna Luisa Kuhn⁸⁰, Dheeraj Gandhi⁸¹, Pankajavalli Ramakrishnan⁸², Roberta Novakovic-White⁸³, Alex Chebl⁸⁴, Odysseas Kargiotis⁸⁵, Alexandra Czap⁸⁶, Alicia Zha⁸⁶, Hesham E Masoud⁸⁷, Carlos Lopez⁸⁷, David Ozretic⁸⁸, Fawaz Al-Mufti⁸⁹, Wenjie Zie⁹⁰, Zhenhui Duan⁹¹, Zhengzhou Yuan⁹², Wenguo Huang⁹³, Yonggang Hao⁹⁴, Jun Luo⁹⁵, Vladimir Kalousek⁹⁶, Romain Bourcier⁹⁷, Romain Guile⁹⁷, Steven Hetts⁹⁸, Hosam M Al-Jehani⁹⁹, Adel AlHazzani¹⁰⁰, Elyar Sadeghi-Hokmabadi⁷, Mohamed Teleb¹⁰¹, Jeremy Payne¹⁰¹, Jin Soo Lee¹⁰², Ji Man Hong¹⁰², Sung-Il Sohn¹⁰³, Yang-Ha Hwang¹⁰⁴, Dong Hoon Shin¹⁰⁵, Hong Gee Roh¹⁰⁶, Randy Edgell¹⁰⁷, Rakesh Khatri¹⁰⁸, Ainsley Smith¹⁰⁹, Amer Malik¹¹⁰, David Liebeskind¹¹¹, Nabeel Herial¹¹², Pascal Jabbour¹¹², Pedro Magalhaes¹¹³, Atilla Ozcan Ozdemir¹¹⁴, Ozlem Aykac¹¹⁴, Takeshi Uwatoko¹¹⁵, Tomohisa Dembo¹¹⁶, Hisao Shimizu¹¹⁷, Yuri Sugiura¹¹⁸, Fumio Miyashita¹¹⁹, Hiroki Fukuda¹²⁰, Kosuke Miyake¹²¹, Junsuke Shimbo¹²², Yusuke Sugimura¹²³, Andre Beer-Furlan¹²⁴, Krishna Joshi¹²⁴, Luciana Catanese¹²⁵, Daniel Giansante Abud¹²⁶, Octavio Giansante Neto¹²⁷, Masoud Mehrpour¹²⁸, Amal Al Hashmi¹²⁹, Mahar Saqqur¹³⁰, Abdulrahman Mostafa¹³¹, Johanna T Fifi¹³², Syed Hussain¹³³, Seby John¹³³, Rishi Gupta¹³⁴, Rotem Sivan-Hoffmann¹³⁵, Anna Reznik¹³⁵, Achmad Fidaus Sani¹³⁶, Serdar Geyik¹³⁷, Eşref Akıl¹³⁷, Anchalee Churojana¹³⁸, Abdoreza Ghoreishi¹³⁹, Mohammad Saadatnia¹⁴⁰, Ehsan Sharifipour¹⁴¹, Alice Ma¹⁴², Ken Faulder¹⁴², Teddy Wu¹⁴³, Lester Leung¹⁴⁴, Adel Malek¹⁴⁵, Barbara Voetsch¹⁴⁶, Ajay Wakhloo¹⁴⁷, Rodrigo Rivera¹⁴⁸, Danny Moises Barrientos Iman¹⁴⁹, Aleksandra Pikula¹⁵⁰, Vasileios-Arsenios Lioutas¹⁴⁶, Gotz Thomalla¹⁵¹, Lee Birnbaum¹⁵², Paolo Machi¹⁵³, Gianmarco Bernava¹⁵³, Mollie McDermott¹⁵⁴, Dawn Kleindorfer¹⁵⁴, Ken Wong¹⁵⁵, Mary S Patterson¹⁵⁶, Jose Antonio Fiorot Jr¹⁵⁷, Vikram Huded¹⁵⁸, William Mack¹⁵⁹, Matthew Tenser¹⁵⁹, Clifford Eskey¹⁶⁰, Sumeet Multani¹⁶¹, Michael Kelly¹⁶², Vallabh Janardhan¹⁶³, Oriana Cornett¹⁶⁴, Varsha Singh¹⁶⁴, Yuichi Murayama¹⁶⁵, Maxim Mokin¹⁶⁶, Pengfei Yang¹⁹, Xiaoxi Zhang¹⁹, Congguo Yin⁵⁰, Hongxing Han¹⁶⁷, Ya Peng¹⁶⁸, Wenhuo Chen¹⁶⁹, Roberto Crosa¹⁷⁰, Michel Eli Frudit¹⁷¹, Jeyaraj D Pandian¹⁷², Anirudh Kulkarni¹⁷², Yoshiki Yagita¹⁷³, Yohei Takenobu¹⁷⁴, Yuji Matsumaru¹⁷⁵, Satoshi Yamada¹⁷⁶, Ryuhei Kono¹⁷⁷, Takuya Kanamaru¹⁷⁸, Hidekazu Yamazaki⁸³, Manabu Sakaguchi¹⁷⁹, Kenichi Todo¹⁸⁰, Nobuaki Yamamoto¹⁸¹, Kazutaka Sonoda¹⁸², Tomoko Yoshida¹⁸³, Hiroyuki Hashimoto¹⁸⁴, Ichiro Nakahara¹⁸⁵, Elena Cora¹⁸⁶, David Volders¹⁸⁶, Celina Ducroux¹⁸⁷, Ashkan Shoamanesh¹⁸⁸, Johanna Ospel¹⁸⁹, Artem Kaliaev¹⁹⁰, Saima Ahmed¹⁹¹, Umair Rashid¹⁹¹, Leticia C Rebello¹⁹², Vitor Mendes Pereira¹⁵⁰, Robert Fahed⁷⁸, Michael Chen¹²⁴, Sunil A Sheth⁸⁶, Lina Palaiodimou¹⁹³, Georgios Tsivgoulis¹⁹³, Ronil Chandra¹⁹⁴, Feliks Koyfman¹⁹⁵, Thomas Leung¹⁹⁶, Houman Khosravani¹⁹⁷, Sushrut Dharmadhikari¹⁹⁸, Giovanni Frisullo¹⁹⁹, Paolo Calabresi¹⁹⁹, Alexander Tsiskaridze²⁰⁰, Nino Lobjanidze²⁰⁰, Mikayel Grigoryan²⁰¹, Anna Czlonkowska²⁰², Diana Aguiar de Sousa²⁰³, Jelle Demeestere²⁰⁴, Conrad Liang²⁰⁵, Navdeep Sangha²⁰⁶, Helmi L Lutsep²⁰⁷, Óscar Ayo-Martín²⁰⁸, Antonio Cruz-Culebras²⁰⁹, Anh D Tran⁵¹, Chang Y Young²¹⁰, Charlotte Cordonnier²¹¹, Francois Caparros²¹¹, Maria Alonso De Lecinana²¹², Blanca Fuentes²¹², Dileep Yavagal¹¹⁰, Tudor Jovin¹⁰⁹, Laurent Spelle¹⁶, Jacques Moret¹⁶, Pooja Khatri²¹³, Osama Zaidat²¹⁴, Jean Raymond⁷⁷, Sheila Martins²¹⁵, Thanh Nguyen²¹⁶

Affiliations

¹ Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA.
² Radiology, Boston Medical Center, Boston University School of Medicine, Boston, USA.
³ Radiology, Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA.
⁴ Neurology Department, Stroke and Neurointervention Division, Alexandria University Hospital, Alexandria University, Egypt.
⁵ Stroke Neurology, National Hospital Organization, Osaka National Hospital, Japan.
⁶ Neurology, Xinqiao Hospital of the Army Medical University, Chongqing, China.
⁷ Tabriz University, Iran.
⁸ Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA.
⁹ Neurology, Radiology, New York University School of Medicine, New York, USA.
¹⁰ Radiology, Neurology, New York University School of Medicine, New York, USA.
¹¹ Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
¹² Neurology, Kobe City Medical Center General Hospital, Kobe, Japan.
¹³ Fondation Ophtalmologique Adolphe de Rothschild, France.
¹⁴ Neurologie, Hospices Civils de Lyon, France.
¹⁵ Neuroradiologie, Hospices Civils de Lyon, France.
¹⁶ Hôpital Bicetre, Paris, France.
¹⁷ Royal Adelaide Hospital, Australia.
¹⁸ Hôpitaux Universitaires de Strasbourg, France.
¹⁹ Changhai Hospital, Shanghai, China.
²⁰ Royal Prince Alfred Hospital, Sydney, Australia.
²¹ Yijishan Hospital of Wannan Medical College, China.
²² Neurology, Hospital Clinic de Barcelona, Spain.
²³ Interventional Neuroradiology, Hospital Clinic de Barcelona, Spain.
²⁴ Neurology, Hospital Clínico Universitario, Valladolid, Spain.
²⁵ Interventional Neuroradiology, Hospital Clínico Universitario, Valladolid, Spain.
²⁶ University Hospital Basel, Switzerland.
²⁷ Clínica Sagrada Familia, Buenos Aires, Argentina.
²⁸ Stroke, Centro Hospitalar Universitário de São João, Portugal.
²⁹ Neuroradiology, Centro Hospitalar Universitário de São João, Portugal.
³⁰ Hospital Geral de Fortaleza, Brazil.
³¹ Careggi University Hospital, Florence, Italy.
³² Neurology, University Hospital Bern, Switzerland.
³³ Interventional Neuroradiology, University Hospital Bern, Switzerland.
³⁴ Swedish Medical Center, USA.
³⁵ MAX Superspecialty Hospital, India.
³⁶ Memorial Neuroscience Institute, Florida.
³⁷ Neurology, University Hospital Heidelberg, Germany.
³⁸ Neuroradiology, University Hospital Heidelberg, Germany.
³⁹ Neurology, University of Iowa, USA.
⁴⁰ Neurosciences, Valley Baptist Medical Center, Harlingen, Texas, USA.
⁴¹ Neurosurgery, University of Cape Town, South Africa.
⁴² Neurology, Hôpital Foch, France.
⁴³ Interventional Neuroradiology, Hôpital Foch, France.
⁴⁴ Royal Melbourne Hospital, Melbourne, Australia.
⁴⁵ Neurology, University of Washington, Seattle, USA.
⁴⁶ Neurosurgery, University of Washington, Seattle, USA.
⁴⁷ Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Germany.
⁴⁸ People's 115 Hospital, Vietnam.
⁴⁹ IMS Tokyo-Katsushika General Hospital, Japan.
⁵⁰ Affiliated Hangzhou First People's Hospital, China.
⁵¹ Hue Central Hospital, Vietnam.
⁵² Erlanger Medical Center, USA.
⁵³ Rutgers University, USA.
⁵⁴ Miami Cardiac and Vascular Institute, USA.
⁵⁵ Nottingham University Hospitals, United Kingdom.
⁵⁶ Clínica Alemana, Universidad del Desarrollo, Chile.
⁵⁷ Universidade Federal de Sao Paulo Hospital Israelita Albert Einstein, Brazil.
⁵⁸ Hospital Israelita Albert Einstein, Brazil.
⁵⁹ Hackensack Meridian Health, New Jersey, USA.
⁶⁰ Kyorin University, Japan.
⁶¹ Yokohama Brain and Spine Center, Japan.
⁶² Iwate Prefectural Central Hospital, Japan.
⁶³ Japanese Red Cross Kyoto Daiichi Hospital, Japan.
⁶⁴ Kyoto Second Red Cross Hospital, Japan.
⁶⁵ Japanese Red Cross Kumamoto Hospital, Japan.
⁶⁶ Kohnan Hospital, Japan.
⁶⁷ Neurology, Maine Medical Center, USA.
⁶⁸ Beaumont Hospital, Dublin, Ireland.
⁶⁹ Hopital Enfant Jesus, Quebec City, Canada.
⁷⁰ Yale New Haven Hospital, USA.
⁷¹ Neurology, University of Calgary, Canada.
⁷² University Hospital Salzburg, Austria.
⁷³ Emory University School of Medicine, USA.
⁷⁴ Valley Hospital, New Jersey, USA.
⁷⁵ University Hospital Germans Trias i Pujol, Barcelona, Spain.
⁷⁶ Lau Medical Center, Beirut, Lebanon.
⁷⁷ CHU Montreal, Canada.
⁷⁸ University of Ottawa, Canada.
⁷⁹ University of South Alabama, USA.
⁸⁰ University of Massachusetts Medical Center, USA.
⁸¹ University of Maryland, USA.
⁸² Riverside Regional Medical Center, Virginia, USA.
⁸³ UT Southwestern, Dallas, Texas, USA.
⁸⁴ Henry Ford Health System, Detroit, USA.
⁸⁵ Metropolitan Hospital, Piraeus, Greece.
⁸⁶ UTHealth McGovern Medical School, Houston, USA.
⁸⁷ SUNY Upstate Medical University Hospital, USA.
⁸⁸ University Hospital Centre Zagreb, Croatia.
⁸⁹ Westchester Medical Center, USA.
⁹⁰ Xinqiao Hospital of the Army Medical University, China.
⁹¹ Wuhan No.1 Hospital, China.
⁹² Affiliated Hospital of Southwest Medical University, China.
⁹³ Maoming Traditional Chinese Medicine Hospital, China.
⁹⁴ Shaw Shaw Hospital, China.
⁹⁵ Mianyang 404 Hospital, China.
⁹⁶ University Clinical Hospital Center Sestre Milosrdnice, Croatia.
⁹⁷ CHU Nantes, France.
⁹⁸ University of California San Francisco, USA.
⁹⁹ King Fahad Hospital of the University, Saudi Arabia.
¹⁰⁰ King Saud University, Saudi Arabia.
¹⁰¹ Banner Desert Medical Center, USA.
¹⁰² Ajou University Hospital, Korea.
¹⁰³ Kyemyung University, Korea.
¹⁰⁴ Kyungpook National University Hospital, Korea.
¹⁰⁵ Gachon University Gil Hospital, Korea.
¹⁰⁶ Konkuk University Hospital, Korea.
¹⁰⁷ St. Louis University, USA.
¹⁰⁸ Texas Tech University, USA.
¹⁰⁹ Cooper University Hospital, USA.
¹¹⁰ University of Miami, USA.
¹¹¹ UCLA, Los Angeles, USA.
¹¹² Thomas Jefferson University Hospital, USA.
¹¹³ Hospital Sao Jose, Brazil.
¹¹⁴ Eskisehir Osmangazi University, Turkey.
¹¹⁵ Saga-ken Medical Centre Koseikan, Japan.
¹¹⁶ Saitama Medical Center, Japan.
¹¹⁷ Nara City Hospital, Japan.
¹¹⁸ Toyonaka Municipal Hospital, Japan.
¹¹⁹ Kagoshima City Hospital, Japan.
¹²⁰ Japanese Red Cross Matsue Hospital, Japan.
¹²¹ Shiroyama Hospital, Japan.
¹²² Niigata City General Hospital, Japan.
¹²³ Sugimura Hospital, Kumamoto, Japan.
¹²⁴ Rush University Medical Center, USA.
¹²⁵ Neurology, McMaster University, Canada.
¹²⁶ Interventional Neuroradiology, Ribeirão Preto Medical School, Brazil.
¹²⁷ Neurosciences, Ribeirão Preto Medical School, Brazil.
¹²⁸ Shahid Beheshti University, Iran.
¹²⁹ Khoula Hospital, Ministry of Health, Oman.
¹³⁰ Hamad Medical Corporation, Qatar.
¹³¹ Alexandria University Hospital, Egypt Hamad Medical Corporation, Qatar.
¹³² Mount Sinai Health System, New York, USA.
¹³³ Cleveland Clinic Abu Dhabi, UAE.
¹³⁴ WellStar Health, Marietta, Georgia, USA.
¹³⁵ Rambam Health Care, Israel.
¹³⁶ General Hospital Dr. Soetomo, Indonesia.
¹³⁷ Istanbul Aydın University, Turkey.
¹³⁸ Siriraj Hospital, Thailand.
¹³⁹ Zanjan University, Iran.
¹⁴⁰ Isfahan University, Iran.
¹⁴¹ Qom University, Iran.
¹⁴² Royal North Shore Hospital, Australia.
¹⁴³ Christchurch Hospital, Christchurch , New Zealand.
¹⁴⁴ Neurology, Tufts Medical Center, USA.
¹⁴⁵ Neurosurgery, Tufts Medical Center, USA.
¹⁴⁶ Neurology, Beth Israel Lahey Health, USA.
¹⁴⁷ Interventional Neuroradiology, Beth Israel Lahey Health, USA.
¹⁴⁸ Neuroradiology, Instituto de Neurocirugia Dr. Asengo, Chile.
¹⁴⁹ National Institute of Neurological Sciences of Lima, Peru.
¹⁵⁰ University of Toronto, Canada.
¹⁵¹ Neurology, Universitätsklinikum Hamburg-Eppendorf, Germany.
¹⁵² University of Texas San Antonio, USA.
¹⁵³ University Hospitals of Geneva, Switzerland.
¹⁵⁴ University of Michigan, USA.
¹⁵⁵ Royal London Hospital, United Kingdom.
¹⁵⁶ Bon Secours Mercy Health, USA.
¹⁵⁷ Hospital-Estadual Central, Brazil.
¹⁵⁸ NH Mazumdar Shaw Medical Center, India.
¹⁵⁹ University of Southern California, USA.
¹⁶⁰ Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
¹⁶¹ Neurology, Bayhealth Medical Center, Delaware, USA.
¹⁶² Neurosurgery, University of Saskatchewan, Canada.
¹⁶³ Medical City Plano Texas, USA.
¹⁶⁴ St. Joseph's University Medical Center, USA.
¹⁶⁵ Jikei University School of Medicine, Japan.
¹⁶⁶ University of South Florida, USA.
¹⁶⁷ Linyi City People Hospital, China.
¹⁶⁸ First People's Hospital, China.
¹⁶⁹ Zhangzhou Municipal Hospital, China.
¹⁷⁰ Centro Endovascular Neurológico Médica, Uruguay.
¹⁷¹ Universidade Federal de Sao Paulo, Brazil.
¹⁷² Christian Medical College, India.
¹⁷³ Kawasaki Medical School, Japan.
¹⁷⁴ Osaka Red Cross Hospital, Japan.
¹⁷⁵ University of Tsukuba, Japan.
¹⁷⁶ Saiseikai Central Hospital, Japan.
¹⁷⁷ Kinikyochuo Hospital, Japan.
¹⁷⁸ NTT Medical Center, Japan.
¹⁷⁹ Osaka General Medical Center, Japan.
¹⁸⁰ Osaka University Graduate School of Medicine, Japan.
¹⁸¹ Tokushima University Graduate School of Biomedical Sciences, Japan.
¹⁸² Saiseikai Fukuoka General Hospital, Japan.
¹⁸³ Tane General Hospital, Japan.
¹⁸⁴ Osaka Rosai Hospital, Japan.
¹⁸⁵ Fujita Health University School of Medicine, Japan.
¹⁸⁶ Dalhousie University, Nova Scotia, Canada.
¹⁸⁷ CHU Montreal, Montreal, Canada.
¹⁸⁸ McMaster University, Canada.
¹⁸⁹ University of Calgary, Canada.
¹⁹⁰ Radiology, Boston Medical Center, USA.
¹⁹¹ Lahore General Hospital, Pakistan.
¹⁹² Hospital Brasilia, Brazil.
¹⁹³ National & Kapodistrian University of Athens, Greece.
¹⁹⁴ Monash Medical Center, Australia.
¹⁹⁵ New York-Presbyterian Queens, USA.
¹⁹⁶ Prince of Wales Hospital, Hong Kong.
¹⁹⁷ Sunnybrook Health Sciences Centre, Canada.
¹⁹⁸ Baptist Health, Arkansas, USA.
¹⁹⁹ Fondazione Policlinico Universitario A.Gemelli, Italy.
²⁰⁰ Ivane Javakhishvili Tbilisi State University, Georgia.
²⁰¹ Adventist Health Glendale, USA.
²⁰² Institute Psychiatry and Neurology, Poland.
²⁰³ Hospital de Santa Maria, Portugal.
²⁰⁴ Leuven University Hospital, Belgium.
²⁰⁵ Neurointerventional Radiology, Kaiser Permanente, California, USA.
²⁰⁶ Neurology, Kaiser Permanente, California, USA.
²⁰⁷ Oregon University, USA.
²⁰⁸ Complejo Hospitalario Universitario de Albacete, Spain.
²⁰⁹ Hospital Universitario Ramon y Cajal, Unidad de Ictus, Spain.
²¹⁰ Asan Medical Center, Korea.
²¹¹ CHU de Lille, France.
²¹² La Paz University Hospital, Madrid, Spain.
²¹³ University of Cincinnati, USA.
²¹⁴ Bon Secours Mercy Health, Toledo, Ohio, USA.
²¹⁵ Hospital de Clínicas de Porto Alegre, Brazil.
²¹⁶ Radiology, Neurology, Boston Medical Center, USA.

PMID: 33459583
PMCID: PMC8010375
DOI: 10.1177/1747493021991652

Observational Study

Global impact of COVID-19 on stroke care

Raul G Nogueira et al. Int J Stroke. 2021 Jul.

. 2021 Jul;16(5):573-584.

doi: 10.1177/1747493021991652. Epub 2021 Mar 29.

Authors

Affiliations

¹ Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA.
² Radiology, Boston Medical Center, Boston University School of Medicine, Boston, USA.
³ Radiology, Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA.
⁴ Neurology Department, Stroke and Neurointervention Division, Alexandria University Hospital, Alexandria University, Egypt.
⁵ Stroke Neurology, National Hospital Organization, Osaka National Hospital, Japan.
⁶ Neurology, Xinqiao Hospital of the Army Medical University, Chongqing, China.
⁷ Tabriz University, Iran.
⁸ Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA.
⁹ Neurology, Radiology, New York University School of Medicine, New York, USA.
¹⁰ Radiology, Neurology, New York University School of Medicine, New York, USA.
¹¹ Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.
¹² Neurology, Kobe City Medical Center General Hospital, Kobe, Japan.
¹³ Fondation Ophtalmologique Adolphe de Rothschild, France.
¹⁴ Neurologie, Hospices Civils de Lyon, France.
¹⁵ Neuroradiologie, Hospices Civils de Lyon, France.
¹⁶ Hôpital Bicetre, Paris, France.
¹⁷ Royal Adelaide Hospital, Australia.
¹⁸ Hôpitaux Universitaires de Strasbourg, France.
¹⁹ Changhai Hospital, Shanghai, China.
²⁰ Royal Prince Alfred Hospital, Sydney, Australia.
²¹ Yijishan Hospital of Wannan Medical College, China.
²² Neurology, Hospital Clinic de Barcelona, Spain.
²³ Interventional Neuroradiology, Hospital Clinic de Barcelona, Spain.
²⁴ Neurology, Hospital Clínico Universitario, Valladolid, Spain.
²⁵ Interventional Neuroradiology, Hospital Clínico Universitario, Valladolid, Spain.
²⁶ University Hospital Basel, Switzerland.
²⁷ Clínica Sagrada Familia, Buenos Aires, Argentina.
²⁸ Stroke, Centro Hospitalar Universitário de São João, Portugal.
²⁹ Neuroradiology, Centro Hospitalar Universitário de São João, Portugal.
³⁰ Hospital Geral de Fortaleza, Brazil.
³¹ Careggi University Hospital, Florence, Italy.
³² Neurology, University Hospital Bern, Switzerland.
³³ Interventional Neuroradiology, University Hospital Bern, Switzerland.
³⁴ Swedish Medical Center, USA.
³⁵ MAX Superspecialty Hospital, India.
³⁶ Memorial Neuroscience Institute, Florida.
³⁷ Neurology, University Hospital Heidelberg, Germany.
³⁸ Neuroradiology, University Hospital Heidelberg, Germany.
³⁹ Neurology, University of Iowa, USA.
⁴⁰ Neurosciences, Valley Baptist Medical Center, Harlingen, Texas, USA.
⁴¹ Neurosurgery, University of Cape Town, South Africa.
⁴² Neurology, Hôpital Foch, France.
⁴³ Interventional Neuroradiology, Hôpital Foch, France.
⁴⁴ Royal Melbourne Hospital, Melbourne, Australia.
⁴⁵ Neurology, University of Washington, Seattle, USA.
⁴⁶ Neurosurgery, University of Washington, Seattle, USA.
⁴⁷ Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Germany.
⁴⁸ People's 115 Hospital, Vietnam.
⁴⁹ IMS Tokyo-Katsushika General Hospital, Japan.
⁵⁰ Affiliated Hangzhou First People's Hospital, China.
⁵¹ Hue Central Hospital, Vietnam.
⁵² Erlanger Medical Center, USA.
⁵³ Rutgers University, USA.
⁵⁴ Miami Cardiac and Vascular Institute, USA.
⁵⁵ Nottingham University Hospitals, United Kingdom.
⁵⁶ Clínica Alemana, Universidad del Desarrollo, Chile.
⁵⁷ Universidade Federal de Sao Paulo Hospital Israelita Albert Einstein, Brazil.
⁵⁸ Hospital Israelita Albert Einstein, Brazil.
⁵⁹ Hackensack Meridian Health, New Jersey, USA.
⁶⁰ Kyorin University, Japan.
⁶¹ Yokohama Brain and Spine Center, Japan.
⁶² Iwate Prefectural Central Hospital, Japan.
⁶³ Japanese Red Cross Kyoto Daiichi Hospital, Japan.
⁶⁴ Kyoto Second Red Cross Hospital, Japan.
⁶⁵ Japanese Red Cross Kumamoto Hospital, Japan.
⁶⁶ Kohnan Hospital, Japan.
⁶⁷ Neurology, Maine Medical Center, USA.
⁶⁸ Beaumont Hospital, Dublin, Ireland.
⁶⁹ Hopital Enfant Jesus, Quebec City, Canada.
⁷⁰ Yale New Haven Hospital, USA.
⁷¹ Neurology, University of Calgary, Canada.
⁷² University Hospital Salzburg, Austria.
⁷³ Emory University School of Medicine, USA.
⁷⁴ Valley Hospital, New Jersey, USA.
⁷⁵ University Hospital Germans Trias i Pujol, Barcelona, Spain.
⁷⁶ Lau Medical Center, Beirut, Lebanon.
⁷⁷ CHU Montreal, Canada.
⁷⁸ University of Ottawa, Canada.
⁷⁹ University of South Alabama, USA.
⁸⁰ University of Massachusetts Medical Center, USA.
⁸¹ University of Maryland, USA.
⁸² Riverside Regional Medical Center, Virginia, USA.
⁸³ UT Southwestern, Dallas, Texas, USA.
⁸⁴ Henry Ford Health System, Detroit, USA.
⁸⁵ Metropolitan Hospital, Piraeus, Greece.
⁸⁶ UTHealth McGovern Medical School, Houston, USA.
⁸⁷ SUNY Upstate Medical University Hospital, USA.
⁸⁸ University Hospital Centre Zagreb, Croatia.
⁸⁹ Westchester Medical Center, USA.
⁹⁰ Xinqiao Hospital of the Army Medical University, China.
⁹¹ Wuhan No.1 Hospital, China.
⁹² Affiliated Hospital of Southwest Medical University, China.
⁹³ Maoming Traditional Chinese Medicine Hospital, China.
⁹⁴ Shaw Shaw Hospital, China.
⁹⁵ Mianyang 404 Hospital, China.
⁹⁶ University Clinical Hospital Center Sestre Milosrdnice, Croatia.
⁹⁷ CHU Nantes, France.
⁹⁸ University of California San Francisco, USA.
⁹⁹ King Fahad Hospital of the University, Saudi Arabia.
¹⁰⁰ King Saud University, Saudi Arabia.
¹⁰¹ Banner Desert Medical Center, USA.
¹⁰² Ajou University Hospital, Korea.
¹⁰³ Kyemyung University, Korea.
¹⁰⁴ Kyungpook National University Hospital, Korea.
¹⁰⁵ Gachon University Gil Hospital, Korea.
¹⁰⁶ Konkuk University Hospital, Korea.
¹⁰⁷ St. Louis University, USA.
¹⁰⁸ Texas Tech University, USA.
¹⁰⁹ Cooper University Hospital, USA.
¹¹⁰ University of Miami, USA.
¹¹¹ UCLA, Los Angeles, USA.
¹¹² Thomas Jefferson University Hospital, USA.
¹¹³ Hospital Sao Jose, Brazil.
¹¹⁴ Eskisehir Osmangazi University, Turkey.
¹¹⁵ Saga-ken Medical Centre Koseikan, Japan.
¹¹⁶ Saitama Medical Center, Japan.
¹¹⁷ Nara City Hospital, Japan.
¹¹⁸ Toyonaka Municipal Hospital, Japan.
¹¹⁹ Kagoshima City Hospital, Japan.
¹²⁰ Japanese Red Cross Matsue Hospital, Japan.
¹²¹ Shiroyama Hospital, Japan.
¹²² Niigata City General Hospital, Japan.
¹²³ Sugimura Hospital, Kumamoto, Japan.
¹²⁴ Rush University Medical Center, USA.
¹²⁵ Neurology, McMaster University, Canada.
¹²⁶ Interventional Neuroradiology, Ribeirão Preto Medical School, Brazil.
¹²⁷ Neurosciences, Ribeirão Preto Medical School, Brazil.
¹²⁸ Shahid Beheshti University, Iran.
¹²⁹ Khoula Hospital, Ministry of Health, Oman.
¹³⁰ Hamad Medical Corporation, Qatar.
¹³¹ Alexandria University Hospital, Egypt Hamad Medical Corporation, Qatar.
¹³² Mount Sinai Health System, New York, USA.
¹³³ Cleveland Clinic Abu Dhabi, UAE.
¹³⁴ WellStar Health, Marietta, Georgia, USA.
¹³⁵ Rambam Health Care, Israel.
¹³⁶ General Hospital Dr. Soetomo, Indonesia.
¹³⁷ Istanbul Aydın University, Turkey.
¹³⁸ Siriraj Hospital, Thailand.
¹³⁹ Zanjan University, Iran.
¹⁴⁰ Isfahan University, Iran.
¹⁴¹ Qom University, Iran.
¹⁴² Royal North Shore Hospital, Australia.
¹⁴³ Christchurch Hospital, Christchurch , New Zealand.
¹⁴⁴ Neurology, Tufts Medical Center, USA.
¹⁴⁵ Neurosurgery, Tufts Medical Center, USA.
¹⁴⁶ Neurology, Beth Israel Lahey Health, USA.
¹⁴⁷ Interventional Neuroradiology, Beth Israel Lahey Health, USA.
¹⁴⁸ Neuroradiology, Instituto de Neurocirugia Dr. Asengo, Chile.
¹⁴⁹ National Institute of Neurological Sciences of Lima, Peru.
¹⁵⁰ University of Toronto, Canada.
¹⁵¹ Neurology, Universitätsklinikum Hamburg-Eppendorf, Germany.
¹⁵² University of Texas San Antonio, USA.
¹⁵³ University Hospitals of Geneva, Switzerland.
¹⁵⁴ University of Michigan, USA.
¹⁵⁵ Royal London Hospital, United Kingdom.
¹⁵⁶ Bon Secours Mercy Health, USA.
¹⁵⁷ Hospital-Estadual Central, Brazil.
¹⁵⁸ NH Mazumdar Shaw Medical Center, India.
¹⁵⁹ University of Southern California, USA.
¹⁶⁰ Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
¹⁶¹ Neurology, Bayhealth Medical Center, Delaware, USA.
¹⁶² Neurosurgery, University of Saskatchewan, Canada.
¹⁶³ Medical City Plano Texas, USA.
¹⁶⁴ St. Joseph's University Medical Center, USA.
¹⁶⁵ Jikei University School of Medicine, Japan.
¹⁶⁶ University of South Florida, USA.
¹⁶⁷ Linyi City People Hospital, China.
¹⁶⁸ First People's Hospital, China.
¹⁶⁹ Zhangzhou Municipal Hospital, China.
¹⁷⁰ Centro Endovascular Neurológico Médica, Uruguay.
¹⁷¹ Universidade Federal de Sao Paulo, Brazil.
¹⁷² Christian Medical College, India.
¹⁷³ Kawasaki Medical School, Japan.
¹⁷⁴ Osaka Red Cross Hospital, Japan.
¹⁷⁵ University of Tsukuba, Japan.
¹⁷⁶ Saiseikai Central Hospital, Japan.
¹⁷⁷ Kinikyochuo Hospital, Japan.
¹⁷⁸ NTT Medical Center, Japan.
¹⁷⁹ Osaka General Medical Center, Japan.
¹⁸⁰ Osaka University Graduate School of Medicine, Japan.
¹⁸¹ Tokushima University Graduate School of Biomedical Sciences, Japan.
¹⁸² Saiseikai Fukuoka General Hospital, Japan.
¹⁸³ Tane General Hospital, Japan.
¹⁸⁴ Osaka Rosai Hospital, Japan.
¹⁸⁵ Fujita Health University School of Medicine, Japan.
¹⁸⁶ Dalhousie University, Nova Scotia, Canada.
¹⁸⁷ CHU Montreal, Montreal, Canada.
¹⁸⁸ McMaster University, Canada.
¹⁸⁹ University of Calgary, Canada.
¹⁹⁰ Radiology, Boston Medical Center, USA.
¹⁹¹ Lahore General Hospital, Pakistan.
¹⁹² Hospital Brasilia, Brazil.
¹⁹³ National & Kapodistrian University of Athens, Greece.
¹⁹⁴ Monash Medical Center, Australia.
¹⁹⁵ New York-Presbyterian Queens, USA.
¹⁹⁶ Prince of Wales Hospital, Hong Kong.
¹⁹⁷ Sunnybrook Health Sciences Centre, Canada.
¹⁹⁸ Baptist Health, Arkansas, USA.
¹⁹⁹ Fondazione Policlinico Universitario A.Gemelli, Italy.
²⁰⁰ Ivane Javakhishvili Tbilisi State University, Georgia.
²⁰¹ Adventist Health Glendale, USA.
²⁰² Institute Psychiatry and Neurology, Poland.
²⁰³ Hospital de Santa Maria, Portugal.
²⁰⁴ Leuven University Hospital, Belgium.
²⁰⁵ Neurointerventional Radiology, Kaiser Permanente, California, USA.
²⁰⁶ Neurology, Kaiser Permanente, California, USA.
²⁰⁷ Oregon University, USA.
²⁰⁸ Complejo Hospitalario Universitario de Albacete, Spain.
²⁰⁹ Hospital Universitario Ramon y Cajal, Unidad de Ictus, Spain.
²¹⁰ Asan Medical Center, Korea.
²¹¹ CHU de Lille, France.
²¹² La Paz University Hospital, Madrid, Spain.
²¹³ University of Cincinnati, USA.
²¹⁴ Bon Secours Mercy Health, Toledo, Ohio, USA.
²¹⁵ Hospital de Clínicas de Porto Alegre, Brazil.
²¹⁶ Radiology, Neurology, Boston Medical Center, USA.

PMID: 33459583
PMCID: PMC8010375
DOI: 10.1177/1747493021991652

Abstract

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.

Keywords: COVID-19; acute ischemic stroke; epidemiology; intracranial hemorrhage; mechanical thrombectomy; stroke care.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

**Figure 1.**
Weekly volume of stroke admissions (ischemic and hemorrhagic) and COVID-19 hospitalizations volumes. *Peak of 1235 COVID hospitalizations in the second week of February, predominantly from one hospital in Wuhan, China.

**Figure 2.**
Weekly volume of mechanical thrombectomy and COVID-19 hospitalizations. *Peak of 1235 COVID hospitalizations in the second week of February, predominantly from one hospital in Wuhan, China.

See this image and copyright information in PMC

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