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Updated: Jun 4, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Impact of COVID-19 pandemic on acute stroke care in a tertiary stroke centre
Máté Héja1, István Fekete2, Sándor Márton3
1Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary. heja.mate@med.unideb.hu.
Insights
The COVID-19 pandemic reduced acute ischemic stroke (AIS) admissions but increased large vessel occlusions (LVOs) and mechanical thrombectomies (MTs). Patients with AIS or hemorrhagic stroke (ICH) and COVID-19 experienced more severe outcomes and higher mortality.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic significantly impacted healthcare systems globally.
- Acute stroke care pathways and patient outcomes may have been affected by the pandemic.
- Understanding these effects is crucial for optimizing stroke management during health crises.
Purpose of the Study:
- To evaluate the impact of COVID-19 on acute stroke care and patient outcomes.
- To compare stroke characteristics and treatment patterns in patients with and without COVID-19.
- To assess the one-year functional outcome and mortality in stroke patients with and without SARS-CoV-2 infection.
Main Methods:
- Retrospective analysis of acute ischemic stroke (AIS) and hemorrhagic stroke (ICH) patients admitted between September 2020 and May 2021.
- Comparison of patients with and without COVID-19, recording demographic, clinical, and imaging data.
- Statistical analysis including chi-squared, Mann-Whitney U, Student t-tests, and multivariate testing.
Main Results:
- A 29% reduction in AIS admissions was observed during the pandemic.
- The number of large vessel occlusions (LVOs) and mechanical thrombectomies (MTs) increased.
- COVID-19 positive patients had higher NIHSS scores, lower favorable outcomes, longer hospitalizations, and increased mortality compared to non-COVID-19 patients. Symptomatic intracerebral hemorrhage (sICH) incidence did not differ.
- ICH patients with COVID-19 showed significantly higher mortality rates at 3 months and 1 year.
Conclusions:
- The pandemic led to fewer AIS admissions but a higher proportion of LVOs requiring MT.
- Concurrent SARS-CoV-2 infection in AIS patients is associated with stroke severity and poor long-term outcomes.
- Reperfusion therapies remain safe and beneficial for selected COVID-19 positive stroke patients. COVID-19 in ICH patients indicates a very poor prognosis.
Abstract:
The aim of this study was to evaluate how COVID-19 affected acute stroke care and outcome in patients with acute ischemic or hemorrhagic stroke. We performed a retrospective analysis on patients who were admitted with acute ischemic (AIS) or hemorrhagic (ICH) stroke from September 2020 to May 2021 with and without COVID-19. We recorded demographic and clinical data, imaging parameters, functional outcome and mortality at one year. Beside descriptive statistics we performed χ2-probe, Mann-Witney U-test, Student t-probe and multivariate testing. We found a 29%-reduction in the number of AIS cases during the pandemic. The number of the large vessel occlusions /LVOs/ (N = 83, 41.7%), from them 37 (17.7%) had mechanical thrombectomy (MT), was higher than before the COVID-19 period (p = 0.02 and p = 0.001, respectively). From all patients needing acute revascularization therapy (N = 137) 118 patients received it, among them 20 (16.9%) had COVID-19. Those positive for COVID-19 were more likely to have a higher median NIHSS score at baseline and at 24 h (p = 0.02 and p = 0.03, respectively). They also had a lower rate of favourable outcome at discharge (15% vs. 41.8%; p = 0.024) and at three months (25% vs. 52%, p = 0.02), longer median hospitalization (p < 0.0001), and a higher mortality rate (52% vs. 25%; p = 0.03). The incidence of symptomatic intracerebral hemorrhage (sICH) did not differ between the groups. Regarding the ICH patients, NIHSS score at 24 h (p = 0.036), mortality at 3 months (p = 0.004) and at one year (p = 0.00) were higher in the COVID-19 group. We concluded that the pandemic resulted fewer admission due to AIS with an increased number of LVOs and MTs. AIS patients with concomitant SARS-CoV-2 infection have more severe strokes and unfavorable long term outcome. The risk of sICH was not increased in COVID-19 positive patients therefore reperfusion therapies appear to be safe and beneficial for some individuals. Patients with ICH and comorbid COVID-19 have a very poor prognosis.
