Related Experiment Video
Updated: Sep 28, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Changes in ischemic stroke presentations, management and outcomes during the first year of the COVID-19 pandemic in
Aravind Ganesh1, Jillian M Stang1, Finlay A McAlister1
1Calgary Stroke Program, Department of Clinical Neurosciences (Ganesh, Holodinsky, Hill, Smith); Departments of Radiology, and of Community Health Sciences (Ganesh, Hill, Smith), Cumming School of Medicine, University of Calgary; Hotchkiss Brain Institute (Ganesh, Hill, Smith); Foothills Medical Centre (Ganesh, Holodinsky, Hill, Smith), Alberta Health Services, Calgary, Alta.; Alberta Health Services (Stang), Red Deer, Alta.; Division of General Internal Medicine, Faculty of Medicine and Dentistry (McAlister), University of Alberta; Alberta Health Services (Shlakhter, Mann); Cardiovascular Health and Stroke Strategic Clinical Network (Mann), Alberta Health Services, Edmonton, Alta.; Department of Medicine (Hill), Cumming School of Medicine, University of Calgary, Calgary, Alta.
Insights
The COVID-19 pandemic reduced ischemic stroke presentations and increased in-hospital deaths. Public health messaging is crucial to encourage emergency care-seeking during pandemics.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Pandemics can lead to hospital avoidance and treatment delays for critical conditions like stroke.
- The COVID-19 pandemic necessitated evaluating its impact on stroke care.
Purpose of the Study:
- To assess changes in ischemic stroke presentations, management, and outcomes during the first year of the COVID-19 pandemic.
- To understand the effect of pandemic waves and restrictions on stroke treatment and patient mortality.
Main Methods:
- A population-based study using linked administrative and stroke registry data from Alberta.
- Analysis of ischemic stroke patients before (Jan. 2016–Feb. 2020) and during the first pandemic year (Feb. 2020–Mar. 2021).
- Evaluation of hospital admissions, emergency department visits, acute therapies (thrombolysis, endovascular therapy), workflow times, and outcomes.
Main Results:
- Ischemic stroke presentations significantly dropped during the first pandemic wave (IRR 0.54).
- While acute therapy rates among presenters did not decline, overall thrombolysis and endovascular therapy incidence decreased.
- In-hospital death risk increased in later pandemic waves (Wave 2 OR 1.48, Wave 3 OR 1.46), and out-of-hospital deaths rose proportionally.
Conclusions:
- The first year of the COVID-19 pandemic was characterized by reduced ischemic stroke presentations, treatment delays, and increased mortality.
- Findings underscore the need for public health campaigns promoting timely care for medical emergencies during pandemics.
- Stroke systems require protocol re-evaluation to enhance efficiency and mitigate pandemic-related care gaps.
Background:
Pandemics may promote hospital avoidance, and added precautions may exacerbate treatment delays for medical emergencies such as stroke. We sought to evaluate ischemic stroke presentations, management and outcomes during the first year of the COVID-19 pandemic.
Methods:
We conducted a population-based study, using linked administrative and stroke registry data from Alberta to identify all patients presenting with stroke before the pandemic (Jan. 1, 2016 to Feb. 27, 2020) and in 5 periods over the first pandemic year (Feb. 28, 2020 to Mar. 31, 2021), reflecting changes in case numbers and restrictions. We evaluated changes in hospital admissions, emergency department presentations, thrombolysis, endovascular therapy, workflow times and outcomes.
Results:
The study included 19 531 patients in the prepandemic period and 4900 patients across the 5 pandemic periods. Presentations for ischemic stroke dropped in the first pandemic wave (weekly adjusted incidence rate ratio [IRR] 0.54, 95% confidence interval [CI] 0.50 to 0.59). Population-level incidence of thrombolysis (adjusted IRR 0.50, 95% CI 0.41 to 0.62) and endovascular therapy (adjusted IRR 0.63, 95% CI 0.47 to 0.84) also decreased during the first wave, but proportions of patients presenting with stroke who received acute therapies did not decline. Rates of patients presenting with stroke did not return to prepandemic levels, even during a lull in COVID-19 cases between the first 2 waves of the pandemic, and fell further in subsequent waves. In-hospital delays in thrombolysis or endovascular therapy occurred in several pandemic periods. The likelihood of in-hospital death increased in Wave 2 (adjusted odds ratio [OR] 1.48, 95% CI 1.25 to 1.74) and Wave 3 (adjusted OR 1.46, 95% CI 1.07 to 2.00). Out-of-hospital deaths, as a proportion of stroke-related deaths, rose during 4 of 5 pandemic periods.
Interpretation:
The first year of the COVID-19 pandemic saw persistently reduced rates of patients presenting with ischemic stroke, recurrent treatment delays and higher risk of in-hospital death in later waves. These findings support public health messaging that encourages care-seeking for medical emergencies during pandemic periods, and stroke systems should re-evaluate protocols to mitigate inefficiencies.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:23Atherosclerosis IV: Nursing Management
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:26Acute Coronary Syndrome V: Nursing Management