Impact of the Coronavirus Disease Pandemic on the Number of Strokes and Mechanical Thrombectomies: A Systematic Review and Meta-Analysis

Abstract

Background This systematic review and meta-analysis aimed to evaluate the impact of the coronavirus disease (COVID-19) pandemic on stroke care, including the number of stroke alerts/codes, number of reperfusions, and number of thrombectomies during the pandemic compared to those during the pre-pandemic period. Methods A systematic literature search was performed using the PubMed, EuropePMC, and Cochrane Central databases. The data of interest were the number of strokes, reperfusions, and mechanical thrombectomies during the COVID-19 pandemic versus that during the pre-pandemic period (in a historical comparator group over a specified period of same period length). Results The study included 59,233 subjects from 9 studies. Meta-analysis showed that the number of stroke alerts during the pandemic was 64% (56–71%) of that during the pre-pandemic period. The number of reperfusion therapies during the pandemic was 69% (61–77%) of that during the pre-pandemic period. Pooled analysis showed that the number of mechanical thrombectomies performed during the pandemic was 78% (75–80%) of that during the pre-pandemic period. The number of mechanical thrombectomies per stroke patient was higher during the pandemic (OR 1.23 [1.12–1.36], p < 0.001; I 2 : 0%, p = 0.845). Conclusion This meta-analysis showed that the number of stroke alerts, reperfusions, and mechanical thrombectomies was reduced by 36%, 31%, and 22%, respectively, during the pandemic. However, the number of patients receiving mechanical thrombectomy per stroke increased.

Prevalence of dementia and its impact on mortality in patients with coronavirus disease 2019: A systematic review and meta‐analysis

“…Furthermore, the pandemic also interrupts dementia research 29 . Patients with dementia might be less able to communicate their medical concerns, and during the pandemic, a visit to hospital is often circumvented; 30,31 the caretakers should be aware to avoid possible delay if one requires urgent medical attention. Efforts should be pursued to mitigate the risk of infection in the community and nursing home, maintaining routine medical care, adapting research methodologies to the current situation, and beyond 32 …”

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

“…In terms of treatment, while 30 cases were reported to have large vessel occlusion, only 20 mechanical thrombectomies were performed. A comprehensive stroke center in Barcelona, Spain reported an 18 and 23% drop in the number of strokes codes and mechanical thrombectomies during the start of the pandemic, respectively, albeit without any changes in reperfusion and clinical outcomes (89) The World Stroke Organization recognizes the said difficulties and emphasizes the utility of telemedicine as well as best practice sharing to further optimize and streamline stroke processes (90,91).…”

Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go?

“…As people continue to adjust to social distancing, a shift in the epidemiology of stroke and other medical conditions will most likely be observed, as is being seen in myocardial infarction [29] and in other countries [30][31][32][33][34][35][36][37] in the context of acute ischemic stroke. Although there is evidence to suggest a high rate of cerebrovascular complications in patients with SARS-CoV-2 infection [38][39][40][41][42][43], anecdotal reports indicate a falling rate of new ischemic stroke admissions [30][31][32]34,37,[44][45][46][47][48], stroke code activations [30,36,[49][50][51][52][53], imaging numbers [44,45], and diagnoses [45].…”

“…Additionally, decreases in acute ischemic stroke treatment numbers have been noted for both thrombolysis [ 46 , 53 , 56 , 57 ] and EVT [ 30 , 33 , 47 , 53 , 56 ], with an excellent meta-analysis presented by July et al [ 53 ], including data from nine studies [ 30 , 56 , 58 - 64 ]. Details of each of these studies, as well as other related studies [ 65 , 66 ], can be found in Table S2 ( Multimedia Appendix 1 ).…”

“…Details of each of these studies, as well as other related studies [ 65 , 66 ], can be found in Table S2 ( Multimedia Appendix 1 ). Interestingly, despite noted decreases in EVT numbers overall, some studies have shown that the proportion of patients receiving EVT increased [ 48 , 53 ], possibly due to an increase in the number of late presenters [ 34 , 58 ] or an increase in the number of patients eligible for EVT. Upon examination, the majority of studies reported no change in process times, such as time last known well (TLKW) to arrival [ 45 , 47 , 49 , 51 ], TLKW to imaging [ 45 ], TLKW to thrombolysis [ 45 , 48 , 49 , 51 ], and length of hospital stay [ 47 ].…”