The Evolution of Acute Cerebrovascular Disease Patient Management in the Post–COVID-19 Period: A Systematic Review.
DOI:
https://doi.org/10.52692/1857-0011.2025.3-83.50Keywords:
stroke, COVID-19, post-pandemic, thrombolysis, thrombectomy, telestrokeAbstract
Stroke represents a major public health issue, causing millions of deaths annually and generating a significant burden in terms of disability. The COVID-19 pandemic profoundly influenced the management of patients with acute stroke, leading to reduced hospital admissions and delays in therapeutic procedures. Studies have shown a decrease in thrombolysis and thrombectomy during the early months, as well as prolonged critical intervals such as “onset-to-door” and “door-to-CT,” mainly due to epidemiological measures and the mandatory use of protective equipment.
In the post-pandemic period, healthcare systems have adapted their protocols, with some being maintained and others discontinued. Recent data indicate improvements in “door-to-needle” times and more efficient clinical workflows. At the same time, the persistence of post-COVID vascular risk complicates patient outcomes, as SARS-CoV-2 infection has been shown to double cardiovascular risk up to three years after the acute episode, with vaccination significantly mitigating these adverse effects.
Innovative methods, such as rapid tests for detecting large vessel occlusions and the expansion of telestroke networks, are modernizing therapeutic strategies. The systematic review of literature published between 2020–2025 highlights regional variability in service organization but also demonstrates a clear trend toward improved efficiency in the post-pandemic era. Conclusions emphasize the need to strengthen telemedicine, standardize protocols, and minimize therapeutic delays to optimize outcomes for stroke patients.
References
Feigin VL, Brainin M, Norrving B, Martins SO, Pandian J, Lindsay P, F Grupper M, Rautalin I. World Stroke Organization: Global Stroke Fact Sheet 2025. Int J Stroke. 2025 Feb;20(2):132-144.
Nogueira RG, Abdalkader M, Qureshi MM, Frankel MR, Mansour OY, Yamagami H,et.al. Global impact of COVID-19 on stroke care. Int J Stroke. 2021 Jul;16(5):573-584.
Nguyen TN, Qureshi MM, Klein P, Yamagami H, Mikulik R, Czlonkowska A, Abdalkader M, Sedova P, Sathya A, Lo HC, Mansour OY, et.al. Global Stroke Registry. Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: A 1-Year Follow-up. Neurology. 2023 Jan 24;100(4):e408-e421.
Hu Q, Hu Y, Gu Y, Song X, Shen Y, Lu H, Zhang L, Liu P, Wang G, Guo C, Fang K, Wang Q. Impact of the COVID-19 pandemic on acute stroke care: An analysis of the 24-month data from a comprehensive stroke center in Shanghai, China. CNS Neurosci Ther. 2023 Jul;29(7):1898-1906 .
de Oliveira LC, Ponciano A, Kashani N, Guarda SNF, Hill MD, Smith EE, Stang JM, Viswanathan A, Turner AC, Ganesh A. Stroke metrics during the first year of the COVID-19 pandemic, a tale of two comprehensive stroke centers. Sci Rep. 2023 Oct 11;13(1):17171.
Gu S, Li J, Shen H, Dai Z, Bai Y, Zhang S, Zhao H, Zhou S, Yu Y, Tang W. The impact of COVID-19 pandemic on treatment delay and short-term neurological functional prognosis for acute ischemic stroke during the lockdown period. Front Neurol. 2022 Oct 20;13:998758
Roper M, Cerilo P, Bena J, Morrison S, Siegmund LA. Patient factors associated with treatment time for
stroke before and after the onset of COVID-19. Geriatr Nurs. 2024 Mar-Apr;56:1-6.
Feigin VL and Owolabi MO, on behalf of the World Stroke Organization–Lancet Neurology Commission Stroke Collaboration Group. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission. Lancet Neurol 2023; 22: 1160–1206.
Baracchini, C. et al. Acute stroke management pathway during Coronavirus-19 pandemic. Neurol. Sci. 41, 1003–1005.
Gluckman, T. J. et al. Case rates, treatment approaches, and outcomes in acute myocardial infarction during the coronavirus disease 2019 pandemic. JAMA Cardiol. 5, 1419–1424.
Nguyen, T. N. et al. Global impact of the COVID-19 pandemic on cerebral venous thrombosis and mortality. J. Stroke 24, 256–265.
Markus, H. S. & Brainin, M. COVID-19 and stroke—A global World Stroke Organization perspective. Int. J. Stroke 15, 361–364.
Teo, K. C. et al. Delays in stroke onset to hospital arrival time during COVID-19. Stroke. 51, 2228–2231.
Khosravani, H., Rajendram, P. & Menon, B. K. Response by Khosravani et al to letter regarding article, “Protected code stroke: hyperacute stroke management during the coronavirus disease 2019 (COVID-19) pandemic”. Stroke. 51, e156–e157.
Kamal, N. et al. Provincial door-to-needle improvement initiative results in improved patient outcomes across an entire population. Stroke. 51, 2339–2346.
Ganesh, A. et al. Changes in ischemic stroke presentations, management and outcomes during the first year of the COVID-19 pandemic in Alberta: A population study. CMAJ. 194, E444–E455.
Ganesh, A., Ospel, J. M., Kromm, J. & Goyal, M. Ignorance is not bliss: Managing uncertainty in acute stroke treatment in the COVID-19 era. Neuroradiology. 63, 3–6.
Nogueira, R. G. et al. Global impact of COVID-19 on stroke care and IV thrombolysis. Neurology. 96(23), e2824–e2838.
Nannoni, S., de Groot, R., Bell, S. & Markus, H. S. Stroke in COVID-19: A systematic review and meta- analysis. Int. J. Stroke 16(2), 137–149.
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