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Updated: Nov 25, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Modification of Acute Stroke Pathway in Korea After the Coronavirus Disease 2019 Outbreak
Tae Jung Kim1,2, Beom Joon Kim3, Dong-Seok Gwak4,5
1Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
Insights
The COVID-19 pandemic initially impacted acute stroke care processes in South Korea, but timely treatment trends and patient outcomes remained largely unaffected. Stroke management protocols adapted to ensure optimal acute care during the pandemic.
Area of Science:
- Neurology
- Public Health
- Emergency Medicine
Background:
- The COVID-19 pandemic necessitated modifications in emergency medical services, potentially affecting acute stroke care delivery.
- Tertiary stroke centers adapted protocols to ensure patient and healthcare professional safety during the pandemic.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on acute stroke care processes and outcomes.
- To assess changes in critical pathway parameters during the pandemic in South Korea.
Main Methods:
- A retrospective analysis of 1,213 acute stroke patients admitted via stroke critical pathways across three centers.
- Data collected included patient demographics, stroke critical pathway metrics (door-to-imaging, door-to-treatment times), and clinical outcomes.
- Interrupted time series analysis was used to assess the pandemic's impact on outcomes and pathway parameters.
Main Results:
- An initial decrease in acute ischemic stroke admissions was observed, particularly in Daegu, an outbreak epicenter, followed by a recovery to pre-pandemic levels.
- Door-to-imaging time showed a temporary increase, and door-to-admission time decreased transiently post-outbreak.
- No significant long-term impact on timely treatment trends, baseline characteristics, or clinical outcomes was detected.
Conclusions:
- The COVID-19 outbreak caused immediate, but not sustained, disruptions to acute stroke care management processes.
- Overall trends in stroke treatment and patient outcomes were not significantly affected by the pandemic.
- Adaptive modification of stroke management protocols is crucial for maintaining optimal acute care during public health crises.
Abstract:
Background: Since the global pandemic of coronavirus disease 2019 (COVID-19), the process of emergency medical services has been modified to ensure the safety of healthcare professionals as well as patients, possibly leading to a negative impact on the timely delivery of acute stroke care. This study aimed to assess the impact of the COVID-19 pandemic on the acute stroke care processes and outcomes in tertiary COVID-19-dedicated centers in South Korea. Methods: We included 1,213 patients with acute stroke admitted to three centers in three cities (Seoul, Seongnam, and Daegu) through the stroke critical pathway between September 2019 and May 2020 (before and during the COVID-19 pandemic). In all three centers, we collected baseline characteristics and parameters regarding the stroke critical pathway, including the number of admitted patients diagnosed with acute stroke through the stroke critical pathway, door to brain imaging time, door to intravenous recombinant tissue plasminogen activator time, door to groin puncture time, and door to admission time. We performed an interrupted time series analysis to determine the impact of the COVID-19 outbreak on outcomes and critical pathway parameters. Results: Three centers modified the protocol of the stroke critical pathway during the COVID-19 pandemic. There was an immediate decrease in the number of patients admitted with acute ischemic stroke after the outbreak of COVID-19 in Korea, especially in the center of Daegu, an epicenter of the COVID-19 outbreak. However, the number of patients with stroke soon increased to equal that before the Covid-19 outbreak. In several critical pathway parameters, door to imaging time showed a temporary increase, and door to admission was transiently decreased after the COVID-19 outbreak. However, there was no significant effect on the timely trend. Moreover, there was no significant difference in the baseline characteristics and clinical outcomes between the periods before and during the COVID-19 pandemic. Conclusion: This study demonstrated that the COVID-19 outbreak immediately affected the management process. However, it did not have a significant overall impact on the trends of stroke treatment processes and outcomes. The stroke management process should be modified according to changing situations for optimal acute management.
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