Is Ischemic Stroke Declines During the COVID-19 Pandemic?

Objective: A decrease in the number of ischemic strokes has been reported during the coronavirus disease-2019 (COVID-19) pandemic period. The aim of this study was to determine the effect of COVID-19 and associated risk factors on the number of ischemic strokes in hospitalizations during the COVID-19 period. Methods: This cross-sectional study was conducted using hospital records. Data of patients who underwent a COVID-19 real -time reversetranscriptase polymerase chain reaction (RT-PCR) test between 2020 and 2021 were included. In addition to RT-PCR test results, the diagnosis of ischemic stroke and known risk factors for ischemic stroke (gender, age, diabetes mellitus, chronic obstructive pulmonary disease, hypertension, hypercholesterolemia, congestive heart failure, coronary artery disease, peripheral vascular disease, chronic kidney disease) were evaluated. Results: According to the inclusion criteria, 25,522 patient records were included in the analysis. There were 123 (0.6%) acute ischemic stroke patients among 19,051 COVID-19-negative patients and 23 (0.4%) among 6471 positive patients. Among the covariates, age and diabetes have a significant effect on acute ischemic stroke. In path analysis, the negative direct effect of RT-PCR positivity on acute ischemic stroke was reversed through the mediator variable effect of diabetes and age. Patients with diabetes and higher age have an increased risk of acute ischemic stroke if they have COVID-19. Conclusion: Evidence is not satisfactory to determine the effect of COVID-19 on ischemic stroke. Reports of a decrease in the number of hospitalizations due to ischemic stroke are accumulating. This result may be due to the direct effect of COVID-19, the lack of recognition of clinical symptoms, or the decrease in hospital admissions of patients without a severe clinical picture. In the presence of accompanying risk factors such as age and diabetes that will aggravate the stroke clinic, the reducing effect of COVID-19 on the number of ischemic strokes disappears.