UMMS Affiliation

New England Center for Stroke Research; Department of Radiology

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Article Postprint


Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Health Services Administration | Health Services Research | Infectious Disease | Nervous System Diseases | Virus Diseases


BACKGROUND: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide.

AIMS: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy (MT), stroke, and intracranial hemorrhage (ICH) hospitalizations over a 3-month period at the height of the pandemic (March 1 to May 31, 2020) compared with two control 3-month periods (immediately preceding and one year prior).

METHODS: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers.

RESULTS: The hospitalization volumes for any stroke, ICH, and MT were 26,699, 4,002, and 5,191 in the 3 months immediately before versus 21,576, 3,540, and 4,533 during the first 3 pandemic months, representing declines of 19.2% (95%CI,-19.7 to -18.7), 11.5% (95%CI,-12.6 to -10.6), and 12.7% (95%CI,-13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/MT centers. High-volume COVID-19 centers (-20.5%) had greater declines in MT volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p < 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions.

CONCLUSION: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, MT procedures, and ICH admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/MT volumes.


Acute stroke therapy, COVID-19, Epidemiology, Intracerebral hemorrahage, Ischaemic stroke, mechanical thrombectomy

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Copyright © 2021. Authors' accepted manuscript posted with a CC BY-NC-ND license as allowed by the publisher's author archiving and green open access guidelines at

DOI of Published Version



Nogueira R, Abdalkader M, Qureshi MM, Frankel MR, Mansour OY, Yamagami H, Qiu Z, Farhoudi M, Siegler JE, Yaghi S, Raz E, Sakai N, Ohara N, Piotin M, Mechtouff L, Eker O, Chalumeau V, Kleinig T, Liu JM, Pop R, Winters HS, Shang X, Rodriguez Vasquez A, Blasco J, Arenillas JF, Martinez-Galdamez M, Brehm A, Psychogios M, Lylyk P, Haussen DC, Al-Bayati A, Mohammaden MH, Fonseca L, Silva MLS, Montalverne FJ, Lima FO, Renieri L, Mangiafico S, Fischer U, Gralla J, Frei D, Chugh C, Mehta BP, Nagel S, Mà Hlenbruch M, Ortega S, Farooqui M, Hassan AE, Taylor A, Lapergue B, Consoli A, Campbell B, Sharma M, Walker M, van Horn N, Fiehler J, Nguyen HT, Nguyen QT, Watanabe D, Zhang H, Le HV, Nguyen VQ, Shah R, Devlin T, Khandelwal P, Linfante I, Izzath W, Lavados P, Olavarrà A VV, Sampaio Silva G, Verena de Carvalho Sousa A, Kirmani J, Bendszus M, Amano T, Yamamoto R, Doijiri R, Tokuda N, Yamada T, Terasaki T, Yazawa Y, Morris JG, Griffin E, Thornton J, Lavoie P, Matouk C, Hill MD, Demchuk AM, Killer M, Nahab F, Altschul D, Perez de la Ossa N, Kikano R, Boisseau W, Walker G, Cordina S, Puri AS, Kuhn A, Gandhi D, Nguyen T. EXPRESS: Global Impact of the COVID-19 Pandemic on Stroke Hospitalizations and Mechanical Thrombectomy Volumes. Int J Stroke. 2021 Jan 18:1747493021991652. doi: 10.1177/1747493021991652. Epub ahead of print. PMID: 33459583. Link to article on publisher's site

Journal/Book/Conference Title

International journal of stroke : official journal of the International Stroke Society


Full author list omitted for brevity. For the full list of authors, see article.

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Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.