Objective To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] −11.7 to −11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI −13.8 to −12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI −13.7 to −10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2–9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.

BACKGROUND: The availability of mechanical thrombectomy (MT) for acute ischemic stroke is limited, and vast disparities exist between countries. We aim to create a MT access score to measure the drivers of access to help quantify and accelerate treatment worldwide. METHODS: We used a systematic review complemented by a modified Delphi method. In the first of 3 rounds, 4 independent investigators performed a systematic literature review using key search terms that drive MT access, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the second round, a panel of 6 anonymous international experts selected key attributes needed for scoring. In the final round, a total of 12 attributes were selected on consensus, each given a score on a 0 to 3 scale. An ultimate MT access score (range, 0–36) was proposed as a new tool to use in identifying barriers to MT access and assist in providing an initial framework for public health interventions. RESULTS: Of 2864 abstracts screened, 121 studies were included in the final systematic review. A total of 34 attributes that potentially drive MT access were initially identified. In the final round, 12 attributes were selected by the expert panel: public awareness, emergency medical services transportation, prehospital large vessel occlusion screening, interhospital transfer policy, emergency department protocols, stroke imaging protocols, emergency department stroke expertise or telestroke availability, interventionalists, MT-capable centers, device availability, and insurance coverage. These attributes were weighted as part of the final score of 0 to 36. CONCLUSIONS: The MT access score represents the first tool to quantify barriers to global MT access. Its implementation stands not just as an academic achievement but as a beacon of hope for improving stroke care and outcomes worldwide, bringing us a step closer to bridging the gap in stroke treatment disparities.

Aneurysmal subarachnoid hemorrhage is one of the feared stroke subtypes with a high degree of morbidity and mortality. Even after the initial treatment of the ruptured aneurysm, patients remain critically ill due to numerous neurologic and systemic sequalae. Among them is cerebral vasospasm, which is a key contributor in the development of delayed cerebral ischemia (DCI). Whereas prevention of DCI with oral nimodipine is standard of care, neurointerventional strategies in the management of DCI are varied. Chemical angioplasty with intra-arterial vasodilators has been a conventional approach when noninvasive medical management fails but is associated with the need for retreatment and therefore felt to be least durable. Balloon angioplasty is also another classically employed, but less frequent intervention, and is limited by utility in the proximal arterial segment, a narrower safety profile, and challenging navigability. More recently, the use of retrievable stents is emerging as a novel strategy with the advantages of improved safety profile, and navigability to treat more distal segments. Here, a selective overview of some of these classic and innovative neurointerventional strategies is presented in the treatment of symptomatic vasospasm/DCI.

Background and Objectives: Hypothyroidism affects 4.6% of the US population, with incidence increasing in recent years. Systemic effects of hypothyroidism include increased serum cholesterol, endothelial dysfunction, and hypertension, which are widely recognized risk factors for stroke. To better understand the prognostic value of thyroid hormone levels in acute ischemic stroke (AIS), this population-based, cross-sectional study aims to examine the clinical outcomes of patients with AIS with hypothyroidism. Methods: The National (Nationwide) Inpatient Sample was queried from 2016 to 2020 for patients with AIS with a diagnosis of hypothyroidism using International Classification of Disease Ninth and Tenth Revision diagnostic codes. patients with AIS with and without hypothyroidism were assessed for baseline clinical characteristics, interventions, complications, and clinical outcomes. Propensity score matched analysis (1:1) was conducted to control for possible confounding variables. Results: Of 2,946,195 patients with AIS identified, 388,235 (13.2%) had a concurrent diagnosis of hypothyroidism. After propensity-score matching, hypothyroidism patients were more likely to experience discharge home (odds ratio (OR) = 0.70; p < 0.01), shorter length of stay (LOS) (4.93 vs. 5.19 days; p < 0.01), and lower rates of inpatient death (OR = 0.80; 95% CI: 0.76–0.84; p < 0.01), compared to patients without hypothyroidism. Conclusions: This retrospective analysis found that patients with hypothyroidism had shorter inpatient LOS, improved discharge disposition, and lower rates of mortality, suggesting that low thyroid hormone levels may be protective in outcomes of AIS. With the rising prevalence of hypothyroidism in the US population, it is increasingly important to investigate its potential effects on patients with cerebrovascular disease.