Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE)

Shahram Abootalebi; Benjamin M Aertker; Mohammad Sobhan Andalibi; Negar Asdaghi; Ozlem Aykac; M Reza Azarpazhooh; M Cecilia Bahit; Kristian Barlinn; Hamidon Basri; Reza Bavarsad Shahripour; Anna Bersano; Jose Biller; Afshin Borhani-Haghighi; Robert D Brown; Bruce Cv Campbell; Salvador Cruz-Flores; Deidre Anne De Silva; Mario Di Napoli; Afshin A Divani; Randall C Edgell; Johanna T Fifi; Abdoreza Ghoreishi; Teruyuki Hirano; Keun-Sik Hong; Chung Y Hsu; Josephine F Huang; Manabu Inoue; Amanda L Jagolino; Moira Kapral; Hoo Fan Kee; Zafer Keser; Rakesh Khatri; Masatoshi Koga; Jerzy Krupinski; David S Liebeskind; Liping Liu; Henry Ma; Alberto Maud; Louise D McCullough; Dawn Matherne Meyer; Victoria Mifsud; Negar Morovatdar; Yongchai Nilanont; Thomas J Oxley; Atilla Özcan Özdemir; Jeyaraj Pandian; Leonardo Pantoni; Nikolaos I H Papamitsakis; Adrian Parry-Jones; Thanh Phan; Gustavo Rodriguez; Jose G Romano; Ziad Sabaa-Ayoun; Hamidreza Saber; Payam Sasannezhad; Jeffrey L Saver; Eugene Scharf; Ashfaq Shuaib; Brian Silver; Shaloo Singhal; Craig J Smith; Saverio Stranges; P N Sylaja; Michel Torbey; Kazunori Toyoda; Georgios Tsivgoulis; Mohammad Wasay; Nawaf Yassi; Takeshi Yoshimoto; Babak Zamani; Ramin Zand

doi:10.1016/j.jstrokecerebrovasdis.2020.104938

Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE)

J Stroke Cerebrovasc Dis. 2020 Sep;29(9):104938. doi: 10.1016/j.jstrokecerebrovasdis.2020.104938. Epub 2020 May 8.

Authors

Shahram Abootalebi¹, Benjamin M Aertker², Mohammad Sobhan Andalibi³, Negar Asdaghi⁴, Ozlem Aykac⁵, M Reza Azarpazhooh⁶, M Cecilia Bahit⁷, Kristian Barlinn⁸, Hamidon Basri⁹, Reza Bavarsad Shahripour¹⁰, Anna Bersano¹¹, Jose Biller¹², Afshin Borhani-Haghighi¹³, Robert D Brown¹⁴, Bruce Cv Campbell¹⁵, Salvador Cruz-Flores¹⁶, Deidre Anne De Silva¹⁷, Mario Di Napoli¹⁸, Afshin A Divani¹⁹, Randall C Edgell²⁰, Johanna T Fifi²¹, Abdoreza Ghoreishi²², Teruyuki Hirano²³, Keun-Sik Hong²⁴, Chung Y Hsu²⁵, Josephine F Huang²⁶, Manabu Inoue²⁷, Amanda L Jagolino²⁸, Moira Kapral²⁹, Hoo Fan Kee³⁰, Zafer Keser³¹, Rakesh Khatri³², Masatoshi Koga³³, Jerzy Krupinski³⁴, David S Liebeskind³⁵, Liping Liu³⁶, Henry Ma³⁷, Alberto Maud³⁸, Louise D McCullough³⁹, Dawn Matherne Meyer⁴⁰, Victoria Mifsud⁴¹, Negar Morovatdar⁴², Yongchai Nilanont⁴³, Thomas J Oxley⁴⁴, Atilla Özcan Özdemir⁵, Jeyaraj Pandian⁴⁵, Leonardo Pantoni⁴⁶, Nikolaos I H Papamitsakis⁴⁷, Adrian Parry-Jones⁴⁸, Thanh Phan⁴⁹, Gustavo Rodriguez³⁸, Jose G Romano⁵⁰, Ziad Sabaa-Ayoun⁵¹, Hamidreza Saber⁵², Payam Sasannezhad⁵³, Jeffrey L Saver⁵⁴, Eugene Scharf⁵⁵, Ashfaq Shuaib⁵⁶, Brian Silver⁵⁷, Shaloo Singhal³⁷, Craig J Smith⁵⁸, Saverio Stranges⁵⁹, P N Sylaja⁶⁰, Michel Torbey⁶¹, Kazunori Toyoda⁶², Georgios Tsivgoulis⁶³, Mohammad Wasay⁶⁴, Nawaf Yassi⁶⁵, Takeshi Yoshimoto⁶⁶, Babak Zamani⁶⁷, Ramin Zand⁶⁸

Affiliations

¹ Dr. Everett Chalmers Regional Hospital, Dalhousie University, New Brunswick, Canada. Electronic address: [email protected].
² Department of Neurology, UTHealth McGovern Medical School, The University of Texas at Houston, Houston, Texas, USA. Electronic address: [email protected].
³ International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address: [email protected].
⁴ Department of Neurology, University of Miami, Miami, Florida, USA. Electronic address: [email protected].
⁵ Department of Neurology and Neurocritical Care, Eskisehir Osmangazi University, Eskişehir, Turkey.
⁶ Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address: [email protected].
⁷ Chief of Cardiology, INECO Neurociencias, Rosario, Argentina.
⁸ Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany. Electronic address: [email protected].
⁹ Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia. Electronic address: [email protected].
¹⁰ University of Tennessee, Comprehensive Stroke center, Memphis, Tennessee, USA. Electronic address: [email protected].
¹¹ Fondazione Istituto Neurologico 'Carlo Besta', Milan, Italy. Electronic address: [email protected].
¹² Department of Neurology, Loyola University Health System, Stritch School of Medicine, Chicago, USA. Electronic address: [email protected].
¹³ Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
¹⁴ Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: [email protected].
¹⁵ Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. Electronic address: [email protected].
¹⁶ Neurology Department, Texas Tech Health University, El Paso, Texas, USA. Electronic address: [email protected].
¹⁷ National Neuroscience Institute, Singapore General Hospital campus, Singapore. Electronic address: [email protected].
¹⁸ Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy. Electronic address: [email protected].
¹⁹ Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA.
²⁰ Department of Neurology, Souers Stroke Institute, Saint Louis University, USA.
²¹ Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA. Electronic address: [email protected].
²² Department of Neurology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
²³ Department of Stroke and Cerebrovascular Medicine, Kyorin University, Japan. Electronic address: [email protected].
²⁴ Department of Neurology, Inje University, Ilsan Paik Hospital, Goyang, Republic of Korea.
²⁵ Graduate Institute of Clinical Medical Science, China Medical University, Taipei, Taichung. Electronic address: [email protected].
²⁶ Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA. Electronic address: [email protected].
²⁷ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: [email protected].
²⁸ Department of Neurology, UTHealth McGovern Medical School, The University of Texas at Houston, Houston, Texas, USA. Electronic address: [email protected].
²⁹ Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada. Electronic address: [email protected].
³⁰ Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
³¹ Department of Neurology, UTHealth McGovern Medical School, The University of Texas at Houston, Houston, Texas, USA. Electronic address: [email protected].
³² Neurology Department, Texas Tech Health University, El Paso, Texas, USA. Electronic address: [email protected].
³³ Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: [email protected].
³⁴ Department of Neurology, Hospital Universitari MutuaTerrassa, Terrassa (Barcelona), Spain; Department of Life Sciences, CBS, Manchester Metropolitan University, Manchester, UK. Electronic address: [email protected].
³⁵ Department of Neurology, Geffen School of Medicine, UCLA, USA. Electronic address: [email protected].
³⁶ Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China.
³⁷ Department of Neurology, Monash Health and Department of Medicine, School of Clinical Sciences Monash University, Australia.
³⁸ Neurology Department, Texas Tech Health University, El Paso, Texas, USA.
³⁹ Department of Neurology, UTHealth McGovern Medical School, The University of Texas at Houston, Houston, Texas, USA. Electronic address: [email protected].
⁴⁰ Department of Neurosciences, UCSD, USA. Electronic address: [email protected].
⁴¹ Neurologic Institute, Cleveland Clinic Abu Dhabi, UAE. Electronic address: [email protected].
⁴² Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address: [email protected].
⁴³ Siriraj Stroke Center, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
⁴⁴ Department of Neurosurgery, Mount Sinai Hospital, New York, USA.
⁴⁵ Department of Neurology, Christian Medical College, Ludhiana, India.
⁴⁶ Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy. Electronic address: [email protected].
⁴⁷ Department of Neurology, SUNY Downstate Medical Center, Brooklyn, New York, USA.
⁴⁸ Manchester Centre for Clinical Neurosciences, Salford Royal National Health Service Foundation Trust, Manchester Academic Health Science Centre, Salford, UK. Electronic address: [email protected].
⁴⁹ Department of Neurology, Monash Health and Department of Medicine, School of Clinical Sciences Monash University, Australia. Electronic address: [email protected].
⁵⁰ Department of Neurology, University of Miami, Miami, Florida, USA. Electronic address: [email protected].
⁵¹ Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario Canada. Electronic address: [email protected].
⁵² David Geffen School of Medicine, Comprehensive Stroke Center, Department of Neurology, University of California, Los Angeles, USA. Electronic address: [email protected].
⁵³ Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address: [email protected].
⁵⁴ Department of Neurology, Geffen School of Medicine, UCLA, USA. Electronic address: [email protected].
⁵⁵ Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: [email protected].
⁵⁶ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: [email protected].
⁵⁷ Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA. Electronic address: [email protected].
⁵⁸ Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, UK; Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK. Electronic address: [email protected].
⁵⁹ Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg. Electronic address: [email protected].
⁶⁰ Comprehensive Stroke Care Program, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum 695 011, Kerala, India.
⁶¹ Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA. Electronic address: [email protected].
⁶² Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: [email protected].
⁶³ Second Department of Neurology, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece.
⁶⁴ Aga Khan University, Karachi, Pakistan. Electronic address: [email protected].
⁶⁵ Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. Electronic address: [email protected].
⁶⁶ Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: [email protected].
⁶⁷ Neurology department of Iran University of Medical Sciences, Tehran, Iran.
⁶⁸ Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA.

PMID: 32807412
PMCID: PMC7205703
DOI: 10.1016/j.jstrokecerebrovasdis.2020.104938

Abstract

Background and purpose: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic.

Methods: This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center.

Conclusion: The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.

Keywords: COVID-19; Health policy; Incidence; Mortality; National crisis; Pandemic; SARS-CoV-2; Stroke.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Betacoronavirus / pathogenicity*
COVID-19
Comorbidity
Coronavirus Infections / diagnosis
Coronavirus Infections / epidemiology*
Coronavirus Infections / mortality
Coronavirus Infections / virology
Healthcare Disparities / trends
Hospital Mortality / trends
Hospitalization / trends*
Host-Pathogen Interactions
Humans
Incidence
Interrupted Time Series Analysis
Pandemics
Pneumonia, Viral / diagnosis
Pneumonia, Viral / epidemiology*
Pneumonia, Viral / mortality
Pneumonia, Viral / virology
Practice Patterns, Physicians' / trends*
Prospective Studies
Registries
Retrospective Studies
Risk Factors
SARS-CoV-2
Stroke / diagnosis
Stroke / epidemiology*
Stroke / mortality
Stroke / therapy*
Time Factors
Treatment Outcome