Department of Radiology, Neurointerventional Radiology
Cardiovascular Diseases | Health Services Administration | Health Services Research | Infectious Disease | Nervous System Diseases | Virus Diseases
BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study's objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.
METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation.
FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p < 0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p < 0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile.
INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction.
aneurysm, coil, haemorrhage, infection, subarachnoid, COVID-19
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DOI of Published Version
Nguyen TN, Haussen DC, Qureshi MM, Yamagami H, Fujinaka T, Mansour OY, Abdalkader M, Frankel M, Qiu Z, Taylor A, Lylyk P, Eker OF, Mechtouff L, Piotin M, Lima FO, Mont'Alverne F, Izzath W, Sakai N, Mohammaden M, Al-Bayati AR, Renieri L, Mangiafico S, Ozretic D, Chalumeau V, Ahmad S, Rashid U, Hussain SI, John S, Griffin E, Thornton J, Fiorot JA, Rivera R, Hammami N, Cervantes-Arslanian AM, Dasenbrock HH, Vu HL, Nguyen VQ, Hetts S, Bourcier R, Guile R, Walker M, Sharma M, Frei D, Jabbour P, Herial N, Al-Mufti F, Ozdemir AO, Aykac O, Gandhi D, Chugh C, Matouk C, Lavoie P, Edgell R, Beer-Furlan A, Chen M, Killer-Oberpfalzer M, Pereira VM, Nicholson P, Huded V, Ohara N, Watanabe D, Shin DH, Magalhaes PS, Kikano R, Ortega-Gutierrez S, Farooqui M, Abou-Hamden A, Amano T, Yamamoto R, Weeks A, Cora EA, Sivan-Hoffmann R, Crosa R, Möhlenbruch M, Nagel S, Al-Jehani H, Sheth SA, Lopez Rivera VS, Siegler JE, Sani AF, Puri AS, Kuhn AL, Bernava G, Machi P, Abud DG, Pontes-Neto OM, Wakhloo AK, Voetsch B, Raz E, Yaghi S, Mehta BP, Kimura N, Murakami M, Lee JS, Hong JM, Fahed R, Walker G, Hagashi E, Cordina SM, Roh HG, Wong K, Arenillas JF, Martinez-Galdamez M, Blasco J, Rodriguez Vasquez A, Fonseca L, Silva ML, Wu TY, John S, Brehm A, Psychogios M, Mack WJ, Tenser M, Todaka T, Fujimura M, Novakovic R, Deguchi J, Sugiura Y, Tokimura H, Khatri R, Kelly M, Peeling L, Murayama Y, Winters HS, Wong J, Teleb M, Payne J, Fukuda H, Miyake K, Shimbo J, Sugimura Y, Uno M, Takenobu Y, Matsumaru Y, Yamada S, Kono R, Kanamaru T, Morimoto M, Iida J, Saini V, Yavagal D, Bushnaq S, Huang W, Linfante I, Kirmani J, Liebeskind DS, Szeder V, Shah R, Devlin TG, Birnbaum L, Luo J, Churojana A, Masoud HE, Lopez CY, Steinfort B, Ma A, Hassan AE, Al Hashmi A, McDermott M, Mokin M, Chebl A, Kargiotis O, Tsivgoulis G, Morris JG, Eskey CJ, Thon J, Rebello L, Altschul D, Cornett O, Singh V, Pandian J, Kulkarni A, Lavados PM, Olavarria VV, Todo K, Yamamoto Y, Silva GS, Geyik S, Johann J, Multani S, Kaliaev A, Sonoda K, Hashimoto H, Alhazzani A, Chung DY, Mayer SA, Fifi JT, Hill MD, Zhang H, Yuan Z, Shang X, Castonguay AC, Gupta R, Jovin TG, Raymond J, Zaidat OO, Nogueira RG; SVIN COVID-19 Registry, the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO); Japanese Society of Vascular and Interventional Neurology Society (JVIN). Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic. Stroke Vasc Neurol. 2021 Mar 26:svn-2020-000695. doi: 10.1136/svn-2020-000695. Epub ahead of print. PMID: 33771936; PMCID: PMC8006491. Link to article on publisher's site
Stroke and vascular neurology
Nguyen TN, Puri AS, Kuhn AL, Nogueira RG. (2021). Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic. COVID-19 Publications by UMMS Authors. https://doi.org/10.1136/svn-2020-000695. Retrieved from https://escholarship.umassmed.edu/covid19/208
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