# Impact of the pandemic and concomitant COVID-19 on the management and outcomes of middle cerebral artery strokes: a nationwide registry-based study

## TL;DR

This study shows that MCA stroke patients with COVID-19 had worse outcomes, including higher mortality and complications, compared to those without the virus.

## Contribution

The study provides new insights into the specific impact of concomitant COVID-19 on MCA stroke outcomes using a nationwide database.

## Key findings

- Patients with MCA strokes and concomitant COVID-19 had significantly higher in-hospital mortality rates.
- They experienced more thromboembolic and respiratory complications compared to those without COVID-19.
- The use of mechanical thrombectomy increased while intravenous thrombolysis decreased during the pandemic.

## Abstract

To investigate the impact of the COVID-19 pandemic as well as concomitant COVID-19 itself on stroke care, focusing on middle cerebral artery (MCA) territory infarctions.

Registry-based study.

We used the National Inpatient Sample (NIS) database, which covers a wide range of hospitals within the USA.

The NIS was queried for patients with MCA strokes between 2016 and 2020. In total, 35 231 patients were included.

Outcome measures were postprocedural complications, length of stays (LOSs), in-hospital mortality and non-routine discharge. Propensity score matching using all available baseline variables was performed to reduce confounders when comparing patients with and without concomitant COVID-19.

Mechanical thrombectomy (MT) was performed in 48.4%, intravenous thrombolysis (IVT) in 38.2%, and both MT and IVT (MT+IVT) in 13.4% of patients. A gradual increase in the use of MT and an opposite decrease in the use of IVT (p<0.001) was detected during the study period. Overall, 25.0% of all patients were admitted for MCA strokes during the pandemic period (2020), of these 209 (2.4%) were concomitantly diagnosed with COVID-19. Patients with MCA strokes and concomitant COVID-19 were significantly younger (64.9 vs 70.0; p<0.001), had significantly worse NIH Stroke Severity scores, and worse outcomes in terms of LOS (12.3 vs 8.2; p<0.001), in-hospital mortality (26.3% vs 9.8%; p<0.001) and non-routine discharge (84.2% vs 76.9%; p=0.013), as compared with those without COVID-19. After matching, only in-hospital mortality rates remained significantly higher in patients with COVID-19 (26.7% vs 8.5%; p<0.001). Additionally, patients with COVID-19 had higher rates of thromboembolic (12.3% vs 7.6%; p=0.035) and respiratory (11.3% vs 6.6%; p=0.029) complications.

Among patients with MCA stroke, those with concomitant COVID-19 were significantly younger and had higher stroke severity scores. They were more likely to experience thromboembolic and respiratory complications and in-hospital mortality compared with matched controls.