Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic: the society of vascular and interventional neurology registry

Introduction: To evaluate overall ischemic stroke rates, specific subtypes, and clinical presentation during the COVID-19 pandemic in a multicenter observational study from eight states across US Methods: We compared all ischemic strokes admitted between January 2019 and May 2020, grouped as;March-May 2020 (COVID-19 period), March-May 2019 (seasonal pre-COVID period) and November 2019-January 2020 (immediate pre-COVID-19 period) Primary outcome was stroke severity at admission measured by NIHSS stratified as mild (0-7), moderate (8-14), and severe (>14) symptoms Secondary outcomes were number of large vessel occlusions (LVOs), stroke etiology, IV-tPA rates, and disposition Results: Of the 7,969 patients diagnosed with acute stroke during the study period, 933 (12%) presented in the COVID-19 period, 1319 (17%), and 1254 (16%) presented in the seasonal pre- COVID-19 and immediate pre-COVID-19 periods, respectively Significant decline was observed in the weekly mean volume of newly diagnosed strokes (98±7 3 vs 50±20, p<0 01 and 95±10 5 vs 50±20, p<0 01), LVOs (16 5±3 8 vs 8 3±5 9, p<0 01 and 14 3± 4 5 vs 8 3±5 9, p<0 01), and IV-tPA (5 3±2 9 vs 10 9±3 4 and 12 7±4 1, p<0 01) Mean weekly proportion of LVOs remained the same, when compared with seasonal pre-COVID-19 period (18%±5 vs 16%±7, p=0 24) and immediate pre-COVID-19 period (17 4%±4 vs 16%±7, p=0 32) Additionally, these patients presented with less severe disease (NIHSS<14;aOR: 0 63, 95%CI: 0 41-0 97, p=0 035) during the COVID-19 period ascompared to immediate pre-COVID-19 period Conclusions: We observed a decrease in newly diagnosed stroke cases and rates of IV-tPAadministration, while the LVO frequency remained unchanged during the COVID-19 pandemic Additionally, these stroke patients had more severe presentations