Stroke and Vascular Neurology ()

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

  • ,
  • Satoshi Yamada,
  • Thomas G Devlin,
  • David S Liebeskind,
  • Michael D Hill,
  • Tudor G Jovin,
  • Jordi Blasco,
  • Raul G Nogueira,
  • John Thornton,
  • Romain Bourcier,
  • Robert Fahed,
  • Michel Piotin,
  • Salvatore Mangiafico,
  • Maxim Mokin,
  • Shadi Yaghi,
  • Diogo C Haussen,
  • Eytan Raz,
  • Italo Linfante,
  • Vitor Mendes Pereira,
  • Monika Killer-Oberpfalzer,
  • Alhamza R Al-Bayati,
  • Patrick Nicholson,
  • Georgios Tsivgoulis,
  • Vanessa Chalumeau,
  • Lissa Peeling,
  • Xianjin Shang,
  • Hao Zhang,
  • Ajit S Puri,
  • Osama O Zaidat,
  • Santiago Ortega-Gutierrez,
  • Dheeraj Gandhi,
  • Gregory Walker,
  • Kenichi Todo,
  • Ameer E Hassan,
  • Michael Chen,
  • Nobuyuki Sakai,
  • William J Mack,
  • Simon Nagel,
  • Pascal Jabbour,
  • Michael Kelly,
  • Don Frei,
  • Hong Gee Roh,
  • Fawaz Al-Mufti,
  • Emma Griffin,
  • Thanh N Nguyen,
  • Alicia C Castonguay,
  • Roberta Novakovic,
  • Mohamad Abdalkader,
  • Mario Martínez-Galdámez,
  • Toshiyuki Fujinaka,
  • Ken Wong,
  • Daisuke Watanabe,
  • Rishi Gupta,
  • Sunil A Sheth,
  • Melanie Walker,
  • Hiroshi Yamagami,
  • Brendan Steinfort,
  • Alex Brehm,
  • Johanna T Fifi,
  • Nobuyuki Ohara,
  • Yuichi Murayama,
  • Ajay K Wakhloo,
  • Wenguo Huang,
  • Gianmarco Bernava,
  • Paolo Machi,
  • Nabeel Herial,
  • Teddy Y Wu,
  • Anna Luisa Kühn,
  • Markus Möhlenbruch,
  • James E Siegler,
  • Stephan A Mayer,
  • Takuya Kanamaru,
  • André Beer-Furlan,
  • Dileep Yavagal,
  • Charles Matouk,
  • Yuji Matsumaru,
  • Pedro Lylyk,
  • Allan Taylor,
  • Leonardo Renieri,
  • Pablo M Lavados,
  • Verónica V Olavarría,
  • Malveeka Sharma,
  • Marios Psychogios,
  • Laura Mechtouff,
  • Vasu Saini,
  • Jun Luo,
  • Barbara Voetsch,
  • Mudassir Farooqui,
  • Ossama Y Mansour,
  • Viktor Szeder,
  • Jean Raymond,
  • Muhammad M Qureshi,
  • Michael Frankel,
  • Zhongming Qiu,
  • Omer F Eker,
  • Fabricio Oliveira Lima,
  • Francisco Mont'Alverne,
  • Wazim Izzath,
  • Mahmoud Mohammaden,
  • David Ozretic,
  • Saima Ahmad,
  • Umair Rashid,
  • Syed Irteza Hussain,
  • Seby John,
  • Jose Antonio Fiorot,
  • Rodrigo Rivera,
  • Nadia Hammami,
  • Anna M Cervantes-Arslanian,
  • Hormuzdiyar H Dasenbrock,
  • Huynh Le Vu,
  • Viet Quy Nguyen,
  • Steven Hetts,
  • Romain Guile,
  • Atilla Ozcan Ozdemir,
  • Ozlem Aykac,
  • Chandril Chugh,
  • Pascale Lavoie,
  • Randall Edgell,
  • Vikram Huded,
  • Dong Hun Shin,
  • Pedro SC Magalhaes,
  • Raghid Kikano,
  • Amal Abou-Hamden,
  • Tatsuo Amano,
  • Ryoo Yamamoto,
  • Adrienne Weeks,
  • Elena A Cora,
  • Rotem Sivan-Hoffmann,
  • Roberto Crosa,
  • Hosam Al-Jehani,
  • Victor S Lopez Rivera,
  • Achmad Fidaus Sani,
  • Daniel G Abud,
  • Octavio M Pontes-Neto,
  • Brijesh P Mehta,
  • Naoto Kimura,
  • Mamoru Murakami,
  • Jin Soo Lee,
  • Ji Man Hong,
  • Eiji Hagashi,
  • Steve M Cordina,
  • Juan F Arenillas,
  • Alejandro Rodriguez Vasquez,
  • Luisa Fonseca,
  • M Luis Silva,
  • Simon John,
  • Matthew Tenser,
  • Tatemi Todaka,
  • Miki Fujimura,
  • Jun Deguchi,
  • Yuri Sugiura,
  • Hiroshi Tokimura,
  • Rakesh Khatri,
  • Hugh Stephen Winters,
  • Johnny Wong,
  • Mohamed Teleb,
  • Jeremy Payne,
  • Hiroki Fukuda,
  • Kosuke Miyake,
  • Junsuke Shimbo,
  • Yusuke Sugimura,
  • Masaaki Uno,
  • Yohei Takenobu,
  • Ryuhei Kono,
  • Masafumi Morimoto,
  • Junichi Iida,
  • Saif Bushnaq,
  • Jawad Kirmani,
  • Ruchir Shah,
  • Lee Birnbaum,
  • Anchalee Churojana,
  • Hesham E Masoud,
  • Carlos Ynigo Lopez,
  • Alice Ma,
  • Amal Al Hashmi,
  • Mollie McDermott,
  • Alex Chebl,
  • Odysseas Kargiotis,
  • Jane G Morris,
  • Clifford J Eskey,
  • Jesse Thon,
  • Leticia Rebello,
  • Dorothea Altschul,
  • Oriana Cornett,
  • Varsha Singh,
  • Jeyaraj Pandian,
  • Anirudh Kulkarni,
  • Yuki Yamamoto,
  • Gisele Sampaio Silva,
  • Serdar Geyik,
  • Jasmine Johann,
  • Sumeet Multani,
  • Artem Kaliaev,
  • Kazutaka Sonoda,
  • Hiroyuki Hashimoto,
  • Adel Alhazzani,
  • David Y Chung,
  • Zhengzhou Yuan

DOI
https://doi.org/10.1136/svn-2020-000695

Abstract

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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.