Results of an International Questionnaire Investigating Changes in Acute Stroke Management between Before and During the COVID-19 Pandemic

OBJECTIVE: The present study investigated changes in the management of acute stroke patients between before and during the coronavirus disease 2019 (COVID-19) pandemic in several countries using a questionnaire. METHODS: A questionnaire survey was conducted at 23 stroke centers in 20 countries to examine how stroke management systems have changed from 2019 (before the COVID-19 pandemic) to 2020 (during the COVID-19 pandemic). RESULTS: Questionnaire responses were obtained from 14 stroke centers (61%) in 14 countries. Among the surveyed stroke centers, 36% utilized full personal protective equipment (PPE) including N95 masks in all cases. After the proper application of infection precautions and screening for COVID-19, the initial imaging modality and indications for endovascular thrombectomy (ET) for ischemic stroke remained unchanged in more than 85% of the surveyed stroke centers. The transmission of COVID-19 from stroke patients to doctors or nurses was confirmed in 29% of the surveyed stroke centers, and hospital-acquired infection from patients to other patients occurred in 25%. The number of cases undergoing ET decreased by 10–70% in 50% of stroke centers during the COVID-19 pandemic. Despite successful recanalization, 50% of patients who underwent ET died, and death was mainly attributed to COVID-19-related systemic complications. CONCLUSION: No significant differences were observed in stroke management or treatment strategies between before and during the COVID-19 pandemic in most stroke centers, except for COVID-19 precautions. However, the higher proportion of hospital-acquired infections and increased morbidity rate among patients despite successful recanalization due to COVID-19-related systemic complications are important findings.