Abstract 14: Global Impact of the Covid-19 Pandemic on Subarachnoid Hemorrhage

Abstract

Introduction: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The objective was to examine whether subarachnoid hemorrhage(SAH) hospitalizations and ruptured aneurysm coiling interventions demonstrated similar declines. Methods: We conducted a global, retrospective, observational study across 6 continents, 37 countries, and 140 comprehensive stroke centers. Patients with diagnosis of SAH, ruptured aneurysm coiling interventions, COVID-19 were identified using ICD-10 codes or by prospectively maintained stroke databases. The 3-month cumulative volume, monthly volumes for SAH hospitalizations and ruptured aneurysm coiling procedures were compared for the period before (1-year and immediately before) and during the COVID-19 pandemic (March 1 to May 31, 2020). Results: There was a significant decline in SAH hospitalizations with 2,044 admissions in the 3 months immediately before and 1,585 admissions during the pandemic, representing a decline of 22.5% (95%CI, -24.3 to -20.7, p<0.0001). Embolization of ruptured aneurysms declined with 1,170 to 1,035 procedures, respectively, representing an 11.5%(95%CI, -13.5 to -9.8, p=0.002) drop. Hospitals with higher COVID-19 hospitalization burden demonstrated greater declines in SAH and ruptured aneurysm coiling compared to lower COVID-19 burden. A relative increase in coiling of ruptured aneurysms was noted in low coiling volume hospitals of 41.1% (95%CI, 32.3-50.6, p=0.008) despite a decrease in SAH admissions in this tertile. Conclusions: There was a global decrease in subarachnoid hemorrhage admissions and ruptured aneurysm embolizations during the COVID-19 pandemic. Among low-volume coiling SAH hospitals, there was an increase in the ruptured aneurysm coiling intervention. These findings in SAH are consistent with a global decrease in other emergencies such as stroke and myocardial infarction.*On behalf of the SVIN COVID-19 Collaborators

Pandemic impact on aneurysmal subarachnoid hemorrhage in Peru’s high COVID-19 lethality setting: A public institutional experience

“…In our study, we observed a decrease in cases of aneurysmal SAH during the first wave of the COVID-19 pandemic (March-October 2020) compared to the 2019 period (49 vs. 65 cases). ese findings are similar to those reported by several authors, such as Nguyen et al, [20] Nogueira et al, [22] and Bernat et al, [5] among others, [4,13,15,26] who found a decline in admissions for acute ischemic and hemorrhagic cerebrovascular diseases during the 1 st months of the pandemic in different countries worldwide. is decline was more evident in hospitals that received a high number of patients infected with COVID-19.…”

Characteristics of subarachnoid hemorrhage associated with COVID-19 infection: A systematic review and descriptive analysis

“…There was a total of 345 COVID-SAH cases reported in the international literature at the time of analysis. This may be underreported, when considering the global decrease in admissions for SAH during the pandemic, attributable to an avoidance in seeking medical care owing to fear of contracting COVID-19 23 , 35 . Whilst most (94.2%) of the COVID-SAH cases were reported in the US, this does not reflect the geographical incidence of SAH, known to be highest in Finland and Japan 16 , 24 .…”

Early recanalization and vasospasm after endovascular treatment in a case of ruptured vertebral artery dissecting aneurysm associated with COVID-19

“…[11] Clinically, ischemic stroke is frequently reported, and management criteria are urgently needed in the US. [7] e risk of developing SAH is currently unknown and considered controversial; [12] however, it is associated with prolonged hospitalization and a poor prognosis. [14] ere are scattered reports of arterial dissection, including ruptured VA dissecting aneurysms.…”