key: cord-326089-8234mcdk
authors: Sweid, Ahmad; Jabbour, Pascal; Tjoumakaris, Stavropoula
title: Incidence of Acute Ischemic Stroke and Rate of Mechanical Thrombectomy During the COVID-19 Pandemic in a Large Tertiary Care Telemedicine Network
date: 2020-06-13
journal: World Neurosurg
DOI: 10.1016/j.wneu.2020.06.053
sha: 
doc_id: 326089
cord_uid: 8234mcdk

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Ahmad Sweid, MD, 1 Pascal Jabbour, MD, 1 Stavropoula Tjoumakaris, MD. 1 

Funding statement: This research received no specific grant from any funding agency in public, commercial, or not-for-profit sectors. Our outcomes (Table 1 ) demonstrate a significant decline in AIS admissions by 23% (p=0.001) and telestroke consults by 48% (p=0.001) compared to similar months in previous years. Contrary, MT procedures increased by 50% (p=0.112) during the same period. Notably, of all thrombectomy cases (24), six were COVID-19 positive, constituting 25% of all thrombectomy patients, which is significantly higher than the expected frequency (incidence of COVID-19 is 1.1%). Lastly, there was no significant delay in diagnosis to intervention (493 mins vs. 544 mins, p=0.401). The precipitous decrease in AIS admissions and telestroke consults may be a consequence of patients not reporting neurological manifestations due to the fear of contracting the virus by visiting the Emergency Room. Also, social distancing may have contributed to lack of detection of neurological changes by family, especially in the elderly population. Such outcomes are consistent with previous reports by the World Stroke Organization (50%-70% decline in AIS admission) and the cardiology experience from the USA (38% decrease in cardiac catheterization lab STEMI activations). 1, 2 The higher incidence of COVID-19 patients in the overall stroke group can be supported by recent theories that systemic COVID-19 may contribute to a hyper-thrombotic state and increase the risk of AIS. 3, 4 This is additionally supported by the fact that the thrombus burden observed during the MT, is significantly higher than historical controls. Of the 6 COVID-19 patients, 4 had tandem occlusions or multiple arterial occlusions (67%) compared to historic controls in our stroke series of 15%.

Nation and worldwide efforts to increase preparedness and hospital efficiency during the pandemic are reflected on the overall lack of significant change in diagnosis to treatment time.

Therefore, based on the undying efforts of frontline medical personnel, patients suffering from AIS may still be able to receive standard of care for medical and interventional treatment. In our series, despite the need for extra precautions, including COVID-19 rapid testing and personal protective equipment, and the decrease in number of health care staff, we did not observe a significant delay to intervention compared to prior years. 

Stroke care and the COVID19 pandemic words from our President. www.worldstroke.org/news-and-blog/news/stroke-care-and-the-covid19-pandemic Accessed 5

Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic

Thromboinflammation and the hypercoagulability of COVID-19

Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19

Temporary Emergency Guidance to US Stroke Centers During the COVID-19 Pandemic

Society of NeuroInterventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of covid-19

The authors have no conflict of interest to report.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Author Agreement: All authors have seen and approved the final version of the manuscript being submitted. The abstract of this study has been accepted at the Annual Meeting of the AANS April 2019, San Diego, CA.