Elena Zapata-Arriaza, MD
International Stroke Conference 2021
March 17–19, 2021
Balucani C, Carhuapoma JR, Canner JK, Faigle R, Johnson B, Aycock A, Phipps MS, Schrier C, Yarbrough K, Toral L, et al. Exploring the Collateral Damage of the COVID-19 Pandemic on Stroke Care: A Statewide Analysis. Stroke. 2021.
The morbidity and mortality effects of COVID-19 are well demonstrated and are a global health priority. The collateral effects of the pandemic on other pathologies that will continue to harm when SARS-CoV-2 becomes endemic have growing evidence. Balucani et al. have performed a retrospective analysis of an existing prospective stroke registry reported by stroke centers in the state of Maryland, between March 1 and September 30, 2020 (pandemic) and the same time period in 2019 (pre-pandemic), in order to explore the effect of the COVID-19 pandemic on transient ischemic attack (TIA) and stroke care.
After data analysis, the authors reported that during the pandemic there was a decrease in the probability of admissions for stroke and TIA by 19%, for acute ischemic stroke by 20%, and for the number of intravenous thrombolysis performed by 23%. There was no difference in the number of admissions for subarachnoid hemorrhage. Furthermore, no significant decrease was observed in the number of thrombectomies performed. Median time from last-well-known to hospital arrival increased in 60.5 min on average.
The results provided by the authors show that patients with severe deficits, such as those with hemorrhagic stroke and large-vessel occlusion stroke, have not decreased their admission rate during the pandemic, precisely because of the unavoidable act of going to the emergency room in patients with severe symptoms. In these cases, the pandemic has also impacted by lengthening the time of access to healthcare by up to one hour, likely in a time-dependent pathology. Fortunately, clinical trials have long allowed us to use multimodal imaging techniques to perform reperfusion therapy in patients with stroke of unknown onset. However, the impact of the pandemic goes further. How many of patients with LVO who underwent thrombectomy were TIAs or minor strokes that stayed at home due to social isolation or the collapse of health services? The collateral effects of SARS-CoV-2 have forced us to improve telecare and to establish circuits that guarantee sufficient assistance for patients in whom time is against them, such as stroke. Despite the rapid health organization of stroke care in most centers globally, the saturation of health systems has prevented giving the best possible stroke care.