Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021;15(8):498-504.
doi: 10.5797/jnet.oa.2021-0072. Epub 2021 Jul 8.

Results of an International Questionnaire Investigating Changes in Acute Stroke Management between Before and During the COVID-19 Pandemic

Kyohei Fujita  1 , Shoko Fujii  1 , Hiroto Yamaoka  1 , Fuga Ayabe  1 , Sakyo Hirai  1 , Kittipong Srivatanakul  2 , Kazutaka Sumita  1
Affiliations

Results of an International Questionnaire Investigating Changes in Acute Stroke Management between Before and During the COVID-19 Pandemic

Kyohei Fujita et al. J Neuroendovasc Ther. 2021.

Abstract

Objective: The present study investigated changes in the management of acute stroke patients between before and during the coronavirus disease 2019 (COVID-19) pandemic in several countries using a questionnaire.

Methods: A questionnaire survey was conducted at 23 stroke centers in 20 countries to examine how stroke management systems have changed from 2019 (before the COVID-19 pandemic) to 2020 (during the COVID-19 pandemic).

Results: Questionnaire responses were obtained from 14 stroke centers (61%) in 14 countries. Among the surveyed stroke centers, 36% utilized full personal protective equipment (PPE) including N95 masks in all cases. After the proper application of infection precautions and screening for COVID-19, the initial imaging modality and indications for endovascular thrombectomy (ET) for ischemic stroke remained unchanged in more than 85% of the surveyed stroke centers. The transmission of COVID-19 from stroke patients to doctors or nurses was confirmed in 29% of the surveyed stroke centers, and hospital-acquired infection from patients to other patients occurred in 25%. The number of cases undergoing ET decreased by 10-70% in 50% of stroke centers during the COVID-19 pandemic. Despite successful recanalization, 50% of patients who underwent ET died, and death was mainly attributed to COVID-19-related systemic complications.

Conclusion: No significant differences were observed in stroke management or treatment strategies between before and during the COVID-19 pandemic in most stroke centers, except for COVID-19 precautions. However, the higher proportion of hospital-acquired infections and increased morbidity rate among patients despite successful recanalization due to COVID-19-related systemic complications are important findings.

Keywords: coronavirus disease 2019; stroke; thrombectomy.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no conflicts of interest regarding this manuscript.

Figures

Fig. 1
Fig. 1. COVID-19 screening tests performed in the emergency room. COVID-19: coronavirus disease 2019; PCR: polymerase chain reaction
Fig. 2
Fig. 2. Outcomes of ET in stroke patients with and without COVID-19. COVID-19: coronavirus disease 2019; ET: endovascular thrombectomy
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Khosravani H, Rajendram P, Notario L, et al. . Protected code stroke: hyperacute stroke management during the coronavirus disease 2019 (COVID-19) pandemic. Stroke 2020; 51: 1891–1895. - PMC - PubMed
    1. Smith MS, Bonomo J, Knight WA, et al. . Endovascular therapy for patients with acute ischemic stroke during the COVID-19 pandemic: a proposed algorithm. Stroke 2020; 51: 1902–1909. - PMC - PubMed
    1. Fraser JF, Arthur AS, Chen M, et al. . Society of neurointerventional surgery recommendations for the care of emergent neurointerventional patients in the setting of COVID-19. J Neurointerv Surg 2020; 12: 539–541. - PubMed
    1. Srivatanakul K, Asai S, Hirayama A, et al. . A protocol of infection control for mechanical thrombectomy in possible COVID-19 patients: Tokai University COVID-19 manual. JNET J Neuroendovasc Ther 2020; 14: 157–161. - PMC - PubMed
    1. Hajdu SD, Pittet V, Puccinelli F, et al. . Acute stroke management during the COVID-19 pandemic: does confinement impact eligibility for endovascular therapy? Stroke 2020; 51: 2593–2596. - PMC - PubMed