{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T12:30:03Z","timestamp":1765888203198,"version":"3.48.0"},"reference-count":27,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T00:00:00Z","timestamp":1709078400000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,2,19]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Registry-based study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>We used the National Inpatient Sample (NIS) database, which covers a wide range of hospitals within the USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The NIS was queried for patients with MCA strokes between 2016 and 2020. In total, 35\u2009231 patients were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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&lt;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&lt;0.001), had significantly worse NIH Stroke Severity scores, and worse outcomes in terms of LOS (12.3 vs 8.2; p&lt;0.001), in-hospital mortality (26.3% vs 9.8%; p&lt;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&lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-080738","type":"journal-article","created":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T03:30:48Z","timestamp":1709091048000},"page":"e080738","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of the pandemic and concomitant COVID-19 on the management and outcomes of middle cerebral artery strokes: a nationwide registry-based study"],"prefix":"10.1136","volume":"14","author":[{"given":"Abdul Karim","family":"Ghaith","sequence":"first","affiliation":[{"name":"Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9479-761X","authenticated-orcid":false,"given":"Victor Gabriel","family":"El-Hajj","sequence":"additional","affiliation":[{"name":"Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elias","family":"Atallah","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5239-7041","authenticated-orcid":false,"given":"Jorge","family":"Rios Zermeno","sequence":"additional","affiliation":[{"name":"Mayo Clinic in Florida, Jacksonville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krishnan","family":"Ravindran","sequence":"additional","affiliation":[{"name":"Mayo Clinic in Florida, Jacksonville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Gharios","sequence":"additional","affiliation":[{"name":"Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry","family":"Hoang","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus","family":"Ohlsson","sequence":"additional","affiliation":[{"name":"Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3776-6136","authenticated-orcid":false,"given":"Adrian","family":"Elmi-Terander","sequence":"additional","affiliation":[{"name":"Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rabih G","family":"Tawk","sequence":"additional","affiliation":[{"name":"Mayo Clinic in Florida, Jacksonville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascal","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,2,27]]},"reference":[{"key":"2025121604253786000_14.2.e080738.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(21)00252-0"},{"key":"2025121604253786000_14.2.e080738.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30925-9"},{"key":"2025121604253786000_14.2.e080738.3","doi-asserted-by":"crossref","unstructured":"GBD 2016 Lifetime Risk of Stroke Collaborators . 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