Evidence map›Paper›PMID 39928659›Full record

ArticlePloS one2025

Impact of the COVID-19 pandemic on outcomes of acute ischemic stroke patients treated with endovascular therapy: A multicenter Canadian study.

Shenghua Zhu, Ammar Alam, Rebecca Thornhill, Vered Tsehmaister-Abitbul, Grant Stotts, Hailey Pettem, Richard Aviv, Ronit Agid, Aleksandra Pikula, Jai Jai Shiva Shankar and 7 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Canadian radiology: 2025 update.Japanese journal of radiology · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Shenghua ZhuDepartment of Radiology, Radiation Oncology and Medical Physics and Department of Surgery, Section of Interventional Neuroradiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Ammar AlamDepartment of Radiology, Radiation Oncology and Medical Physics and Department of Surgery, Section of Interventional Neuroradiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Rebecca ThornhillDepartment of Radiology, Radiation Oncology and Medical Physics and Department of Surgery, Section of Interventional Neuroradiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.ORCID 0000-0001-5308-5106
Vered Tsehmaister-AbitbulDepartment of Radiology, Radiation Oncology and Medical Physics and Department of Surgery, Section of Interventional Neuroradiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.ORCID 0000-0002-8651-4541
Grant StottsDepartment of Medicine, Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada.
Hailey PettemDepartment of Medicine, Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada.
Richard AvivDepartment of Radiology, Radiation Oncology and Medical Physics and Department of Surgery, Section of Interventional Neuroradiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.ORCID 0000-0003-0259-970X
Ronit AgidDepartment of Medical Imaging, Division of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.
Aleksandra PikulaDepartment of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
Jai Jai Shiva ShankarDepartment of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.
Genevieve MilotDepartment of Surgery, Division of Neurosurgery, CHU de Québec - Université Laval, Quebec City, Quebec, Canada.
Brian Van AdelDivisions of Neurosurgery and Neurointerventional Surgery, McMaster University, Hamilton, Ontario, Canada.
Samuel YipDepartment of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.
Manraj HeranDepartment of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
Robert FahedDepartment of Medicine, Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada.
Fabio SettecaseDepartment of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
Marlise P Dos SantosDepartment of Radiology, Radiation Oncology and Medical Physics and Department of Surgery, Section of Interventional Neuroradiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.ORCID 0000-0002-7489-0822

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe novel coronavirus disease 2019 (COVID-19) pandemic led to the implementation of wide-ranging institutional infection control protocols. The purpose of this study is to determine the effect of the pandemic on outcomes of large vessel occlusion (LVO) acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT). MATERIALS AND

methodsData were obtained from prospectively collected quality improvement stroke databases at six Canadian comprehensive stroke centres from March 11, 2020 to March 11, 2021. This patient cohort was compared to pre-pandemic patients consecutively treated with EVT from March 11, 2019 to March 10, 2020. The primary outcome is a 90-day modified Rankin Score (mRS). The secondary outcomes are angiographic time metrics.

resultsA total of 1329 EVT patients (pre-pandemic n = 666) were included. The initial NIHSS was statistically significantly lower in the pandemic cohort. Other baseline patient characteristics were comparable between the two periods. Median (interquartile range, IQR) time from last seen normal (LSN) to emergency department (ED) (172 (68-316) vs 210 (97-382) min; p = 0.0001), LSN to puncture (235 (160-378) vs 280 (184-475); p < 0.0001), computed tomography (CT) to angiographic table (68 (44-108) vs 84 (57-125) min; p = 0.002), ED to angiographic table (65 (37-96) vs 80 (50-112) min; p = 0.001), CT to recanalization (117 (84-156) vs 130 (89-173) min; p = 0.038) and LSN to recanalization (279 (198-453) vs 327 (219-561) min; p = 0.002) were longer in the pandemic period as compared to the pre-pandemic. There were no significant differences in median time from angiographic table to arterial puncture (13 (8-19) vs 12 (9-16) min; p = 0.70) or arterial puncture to first pass (21 (14-31) vs 20 (14-30) min; p = 0.50). Patients were more likely to have favourable outcomes (mRS at 90 days score of ≤ 2) post-EVT pre-pandemic than pandemic (53% vs 44%; p = 0.02). Furthermore, analysis of the time interval from "LSN to arterial puncture" in relation to functional outcomes showed that the percentage of unfavorable outcomes increased among patients who underwent EVT within 240 minutes. Specifically, the rate of unfavorable outcomes rose from 32.9% to 42.9% (p = 0.37 for intervals under 150 minutes) and from 41.6% to 52.3% (p = 0.15 for intervals between 151 and 240 minutes) when comparing pre-pandemic to pandemic periods. However, the detrimental effect associated with the pandemic was diminished in patients who received EVT beyond 240 mins (p = 1.0).

conclusionIn this multicenter study involving six Canadian stroke centers, patients exhibited a higher probability of unfavorable long-term functional outcomes following EVT during the pandemic period compared to those in the pre-pandemic cohort, particularly during the first year of the pandemic.

Indexed as

COVID-19Endovascular ProceduresIschemic StrokeAgedAged, 80 and overCanadaFemaleHumansMaleMiddle AgedPandemicsSARS-CoV-2Treatment Outcome

Identifiers

PMID39928659
PMCPMC11809926

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.