Global Impact of COVID-19 on Stroke Care and IV Thrombolysis

Nogueira R.G. Qureshi M.M. Abdalkader M. Martins S.O. Yamagami H. Qiu Z. Mansour O.Y. Sathya A. Czlonkowska A. Tsivgoulis G. De Sousa D.A. Demeestere J. Mikulik R. Vanacker P. Siegler J.E. Kõrv J. Biller J. Liang C.W. Sangha N.S. Zha A.M. Czap A.L. Holmstedt C.A. Turan T.N. Ntaios G. Malhotra K. Tayal A. Loochtan A. Ranta A. Mistry E.A. Alexandrov A.W. Huang D.Y. Yaghi S. Raz E. Sheth S.A. Mohammaden M.H. Frankel M. Bila Lamou E.G. Aref H.M. Elbassiouny A. Hassan F. Menecie T. Mustafa W. Shokri H.M. Roushdy T. Sarfo F.S. Alabi T.O. Arabambi B. Nwazor E.O. Sunmonu T.A. Wahab K. Yaria J. Mohammed H.H. Adebayo P.B. Riahi A.D. Sassi S.B. Gwaunza L. Ngwende G.W. Sahakyan D. Rahman A. Ai Z. Bai F. Duan Z. Hao Y. Huang W. Li G. Li W. Liu G. Luo J. Shang X. Sui Y. Tian L. Wen H. Wu B. Yan Y. Yuan Z. Zhang H. Zhang J. Zhao W. Zi W. Leung T.W. Chugh C. Huded V. Menon B. Pandian J.D. Sylaja P.N. Usman F.S. Farhoudi M. Hokmabadi E.S. Horev A. Reznik A. Hoffmann R.S. Ohara N. Sakai N. Watanabe D. Yamamoto R. Doijiri R. Tokuda N. Yamada T. Terasaki T. Yazawa Y. Uwatoko T. Dembo T. Shimizu H. Sugiura Y. Miyashita F. Fukuda H. Miyake K. Shimbo J. Sugimura Y. Yagita Y. Takenobu Y. Matsumaru Y. Yamada S. Kono R. Kanamaru T. Yamazaki H. Sakaguchi M. Todo K. Yamamoto N. Sonoda K. Yoshida T. Hashimoto H. Nakahara I. Kondybayeva A. Faizullina K. Kamenova S. Zhanuzakov M. Baek J.-H. Hwang Y. Lee J.S. Lee S.B. Moon J. Park H. Seo J.H. Seo K.-D. Sohn S.I. Young C.J. Ahdab R. Wan Zaidi W.A. Aziz Z.A. Basri H.B. Chung L.W. Ibrahim A.B. Ibrahim K.A. Looi I. Tan W.Y. Yahya N.W. Groppa S. Leahu P. Al Hashmi A.M. Imam Y.Z. Akhtar N. Pineda-Franks M.C. Co C.O. Kandyba D. Alhazzani A. Al-Jehani H. Tham C.H. Mamauag M.J. Venketasubramanian N. Chen C.-H. Tang S.-C. Churojana A. Akil E. Aykaç Ö. Ozdemir A.O. Giray S. Hussain S.I. John S. Le Vu H. Tran A.D. Nguyen H.H. Pham T.N. Nguyen T.H. Nguyen T.Q. Gattringer T. Enzinger C. Killer-Oberpfalzer M. Bellante F. De Blauwe S. Vanhooren G. De Raedt S. Dusart A. Lemmens R. Ligot N. Rutgers M.P. Yperzeele L. Alexiev F. Sakelarova T. Bedeković M.R. Budincevic H. Cindric I. Hucika Z. Ozretic D. Saric M.S. Pfeifer F. Karpowic I. Cernik D. Sramek M. Skoda M. Hlavacova H. Klecka L. Koutny M. Vaclavik D. Skoda O. Fiksa J. Hanelova K. Nevsimalova M. Rezek R. Prochazka P. Krejstova G. Neumann J. Vachova M. Brzezanski H. Hlinovsky D. Tenora D. Jura R. Jurák L. Novak J. Novak A. Topinka Z. Fibrich P. Sobolova H. Volny O. Christensen H.K. Drenck N. Klingenberg Iversen H. Simonsen C.Z. Truelsen T.C. Wienecke T. Vibo R. Gross-Paju K. Toomsoo T. Antsov K. Caparros F. Cordonnier C. Dan M. Faucheux J.-M. Mechtouff L. Eker O. Lesaine E. Ondze B. Peres R. Pico F. Piotin M. Pop R. Rouanet F. Gubeladze T. Khinikadze M. Lobjanidze N. Tsiskaridze A. Nagel S. Ringleb P.A. Rosenkranz M. Schmidt H. Sedghi A. Siepmann T. Szabo K. Thomalla G. Palaiodimou L. Sagris D. Kargiotis O. Klivenyi P. Szapary L. Tarkanyi G. Adami A. Bandini F. Calabresi P. Frisullo G. Renieri L. Sangalli D. Pirson A. Uyttenboogaart M. Van Den Wijngaard I. Kristoffersen E.S. Brola W. Fudala M. Horoch-Lyszczarek E. Karlinski M. Kazmierski R. Kram P. Rogoziewicz M. Kaczorowski R. Luchowski P. Sienkiewicz-Jarosz H. Sobolewski P. Fryze W. Wisniewska A. Wiszniewska M. Ferreira P. Ferreira P. Fonseca L. Marto J.P. Pinho E Melo T. Nunes A.P. Rodrigues M. Cruz V.T. Falup-Pecurariu C. Krastev G. Mako M. De Leciñana M.A. Arenillas J.F. Ayo-Martin O. Culebras A.C. Tejedor E.D. Montaner J. Pérez-Sánchez S. Tola Arribas M.A. Rodriguez Vasquez A. Mayza M. Bernava G. Brehm A. Machi P. Fischer U. Gralla J. Michel P.L. Psychogios M.-N. Strambo D. Banerjee S. Krishnan K. Kwan J. Butt A. Catanese L. Demchuk A.M. Field T. Haynes J. Hill M.D. Khosravani H. Mackey A. Pikula A. Saposnik G. Scott C.A. Shoamanesh A. Shuaib A. Yip S. Barboza M.A. Barrientos J.D. Portillo Rivera L.I. Gongora-Rivera F. Novarro-Escudero N. Blanco A. Abraham M. Alsbrook D. Altschul D. Alvarado-Ortiz A.J. Bach I. Badruddin A. Barazangi N. Brereton C. Castonguay A. Chaturvedi S. Chaudry S.A. Choe H. Choi J.H. Dharmadhikari S. Desai K. Devlin T.G. Doss V.T. Edgell R. Etherton M. Farooqui M. Frei D. Gandhi D. Grigoryan M. Gupta R. Hassan A.E. Helenius J. Kaliaev A. Kaushal R. Khandelwal P. Khawaja A.M. Khoury N.N. Kim B.S. Kleindorfer D.O. Koyfman F. Lee V.H. Leung L.Y. Linares G. Linfante I. Lutsep H.L. Macdougall L. Male S. Malik A.M. Masoud H. Mcdermott M. Mehta B.P. Min J. Mittal M. Morris J.G. Multani S.S. Nahab F. Nalleballe K. Nguyen C.B. Novakovic-White R. Ortega-Gutierrez S. Rahangdale R.H. Ramakrishnan P. Romero J.R. Rost N. Rothstein A. Ruland S. Shah R. Sharma M. Silver B. Simmons M. Singh A. Starosciak A.K. Strasser S.L. Szeder V. Teleb M. Tsai J.P. Voetsch B. Balaguera O. Pujol Lereis V.A. Luraschi A. Almeida M.S. Cardoso F.B. Conforto A. De Deus Silva L. Varrone Giacomini L. Oliveira Lima F. Longo A.L. Magalhães P.S.C. Martins R.T. Montalverne F. Mora Cuervo D.L. Costa Rebello L. Valler L. Zetola V.F. Lavados P.M. Navia V. Olavarría V.V. Almeida Toro J.M. Amaya P.F.R. Bayona H. Corredor A. Rivera Ordonez C.E. Mantilla Barbosa D.K. Lara O. Patiño M.R. Diaz Escobar L.F. Farina D.E.D.M. Cardozo Villamayor A. Zelaya Zarza A.J. Barrientos Iman D.M. Rodriguez Kadota L. Campbell B. Hankey G.J. Hair C. Kleinig T. Ma A. Tomazini Martins R. Sahathevan R. Thijs V. Salazar D. Yuan-Hao Wu T. Haussen D.C. Liebeskind D. Yavagal D.R. Jovin T.G. Zaidat O.O. Nguyen T.N.
8 June 2021 Lippincott Williams and Wilkins

Neurology
2021 #96 Issue 23 E2824 - E2838 pp.

Objective To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] −11.7 to −11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI −13.8 to −12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI −13.7 to −10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2–9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months. Copyright

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Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, United States
Department of Radiology, Boston Medical Center, Boston University School of Medicine, MA, United States
Radiation Oncology, Boston Medical Center, Boston University School of Medicine, MA, United States
Department of Neurology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Hospital de Clínicas de Porto Alegre, Brazil
Department of Stroke Neurology, National Hospital Organization, Osaka National Hospital, Japan
Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China
Department of Neurology, Stroke and Neurointervention Division, Alexandria University Hospital, Alexandria University, Egypt
Boston University School of Medicine, MA, United States
2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
Department of Neurology, Leuven University Hospital, Belgium
International Clinical Research Center, Department of Neurology, St. Annes University Hospital in Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
Department of Neurology, Groeninge Hospital, Kortrijk, Belgium
Department of Neurology, University Hospitals Antwerp, Belgium
Department of Translational Neuroscience, University of Antwerp, Belgium
Department of Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, United States
Department of Neurology and Neurosurgery, University of Tartu, Estonia
Department of Neurology, Loyola University Chicago Stritch School of Medicine, IL, United States
Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, United States
Department of Neurology, Kaiser Permanente Los Angeles Medical Center, United States
Department of Neurology, UT Health McGovern Medical School, Houston, TX, United States
Department of Neurology, Medical University of South Carolina, Charleston, United States
Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
Department of Neurology, Allegheny Health Network, Pittsburgh, PA, United States
Department of Neurology, Ohio Health Riverside Methodist Hospital Columbus, United States
Department of Medicine and Neurology, University of Otago, Wellington Hospital, New Zealand
Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
Department of Neurology, University of Tennessee Health Center, Memphis, United States
Department of Neurology, University of North Carolina, Chapel Hill, United States
Department of Neurology, New York University Grossman School of Medicine, United States
Department of Radiology, New York University Grossman School of Medicine, United States
Douala Gynaeco-Obstetric and Pediatric Hospital, University of Douala, Faculty of Medicine and Pharmaceutical Science, Cameroon
Ain Shams University Specialized Hospital, Nasser Institute for Research and Treatment, Cairo, Egypt
Cairo University Affiliated MOH Network, Nasser Institute for Research and Treatment, Cairo, Egypt
Department of Neurology, Nasser Institute for Research and Treatment, Cairo, Egypt
Mansoura University Affiliated Private Hospitals Network, Egypt
Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Stroke Unit, University of Ilorin Teaching Hospital, Nigeria
Neurology Unit, Department of Medicine, Lagos State University Teaching Hospital, Nigeria
Department of Medicine, Federal Medical Centre Owerri, Imo State, Nigeria
Neurology Unit, Department of Medicine, Federal Medical Centre, Ondo State, Owo, Nigeria
University College Hospital, Ibadan, Nigeria
National Ribat University Affiliated Hospitals, Khartoum, Sudan
Neurology Section, Department of Internal Medicine, Aga-Khan University, Medical College East Africa, Dar es Salaam, Tanzania
Tunis El Manar University, Military Hospital of Tunis, University Tunis El Manar, Tunisia
Department of Neurology, Mongi Ben Hmida National Institute of Neurology, Faculty of Medicine of Tunis, University Tunis El Manar, Tunisia
Department of Physiology, Parirenyatwa Hospital, University of Zimbabwe, Harare, Zimbabwe
Department of Physiology and Medicine, University of Zimbabwe, Harare, Zimbabwe
Department of Cerebrovascular, Endovascular Neurosurgery Division, Erebouni Medical Center, Yerevan, Armenia
Department of Neurology, Sir Salimulah College, Dhaka, Bangladesh
Department of Neurology, Taihe Hospital of Shiyan City, Hubei, China
Department of Neurology, Nanyang Central Hospital, Henan, China
Department of Neurology, Wuhan No. 1 Hospital, Hubei, China
Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, China
Department of Neurology, Traditional Chinese Medicine Hospital of Maoming, Guangdong, China
Department of Neurology, Affiliated Hospital of Qingdao University, Shandong, China
Department of Neurology, First Affiliated Hospital of Hainan Medical College, China
Department of Neurology, Wuhan Central Hospital, Hubei, China
Department of Neurology, Mianyang 404th Hospital, Sichuan, China
Department of Neurology, Yijishan Hospital of Wannan Medical College, Anhui, China
Department of Neurology and Neuroscience, Shenyang Brain Institute, Shenyang First People’s Hospital, Shenyang Medical College Affiliated Brain Hospital, China
Department of Neurology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Shandong, China
Department of Neurology, Xiangyang Central Hospital, Hubei, China
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
Department of Neurology, Affiliated Hospital of Southwest Medical University, Sichuan, China
Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, China
Department of Neurology, First Affiliated Hospital of Shandong First Medical University, China
Department of Neurology, First Affiliated Hospital of Fujian Medical University, China
Acute Stroke Unit, The Prince of Wales Hospital, Kwok Tak Seng Centre for Stroke Research and Intervention, The Chinese University of Hong Kong, China
Interventional Neurology, MAX Superspecialty Hospital, Saket, New Delhi, India
NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bangalore, India
Department of Neurology, Apollo Speciality Hospitals Nellore, India
Department of Neurology, Christian Medical College, Punjab, Ludhiana, India
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India
Stroke Unit, Pelni Hospital, Jakarta, Indonesia
Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Beer Sheva Hospital, Israel
Department of Interventional Neuroradiology, Rambam Healthcare Campus, Haifa, Israel
Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
Department of Stroke and Neurovascular Surgery, IMS Tokyo-Katsushika General Hospital, Japan
Yokohama Brain and Spine Center, Japan
Iwate Prefectural Central, Japan
Department of Neurology and Stroke Treatment, Japanese Red Cross Kyoto Daiichi Hospital, Japan
Department of Neurology, Kyoto Second Red Cross Hospital, Japan
Department of Neurology, Japanese Red Cross Kumamoto Hospital, Japan
Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan
Department of Cerebrovascular Medicine, Saga-Ken Medical Centre, Japan
Department of Neurology, Saitama Medical Center, Kawagoe, Japan
Department of Neurology, Nara City Hospital, Japan
Department of Neurology, Toyonaka Municipal Hospital, Osaka, Japan
Department of Neurology, Kagoshima City Hospital, Japan
Department of Neurology, Japanese Red Cross Matsue Hospital, Shimane, Japan
Department of Neurology, Shiroyama Hospital, Osaka, Japan
Department of Cerebrovascular Medicine, Niigata City General Hospital, Japan
Department of Neurology, Sugimura Hospital, Kumamoto, Japan
Stroke Medicine, Kawasaki Medical School, Okayama, Japan
Department of Neurology, Osaka Red Cross Hospital, Japan
Department of Stroke Prevention and Treatment, Department of Neurosurgery, University of Tsukuba, Ibaraki, Japan
Department of Neurology, Stroke Center and Neuroendovascular Therapy, Saiseikai Central Hospital, Tokyo, Japan
Department of Neurology, Kin-ikyo Chuo Hospital, Hokkaido, Japan
Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Japan
Department of Neurology and Neuroendovascular Treatment, Yokohama Shintoshi Neurosurgical Hospital, Japan
Department of Neurology, Osaka General Medical Center, Japan
Department of Neurology, Osaka University Hospital, Japan
Department of Advanced Brain Research, Tokushima University Hospital Tokushima, Japan
Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
Department of Neurology, Tane General Hospital, Osaka, Japan
Division of Stroke, Department of Internal Medicine, Osaka Rosai Hospital, Japan
Department of Comprehensive Stroke, Fujita Health University School of Medicine, Toyoake, Japan
Department of Neurology, Asfendiyarov Kazakh National Medical University, Japan
Republican Center for eHealth, Ministry of Health of the Republic of Kazakhstan, Kazakhstan
Department of Medicine, Al-Farabi Kazakh National University, Kazakhstan
Kazakh-Russian Medical University, Kazakhstan
Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, South Korea
Ajou University Hospital, South Korea
Department of Neurology, Uijeongbu St. Mary’s Hospital, College of Medicine, Catholic University of Korea, South Korea
Department of Neurology, National Medical Center, Seoul, South Korea
Department of Neurology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, South Korea
Department of Neurology, Busan Paik Hospital, School of Medicine, Inje University, Busan, South Korea
Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
Asan Medical Center, Seoul, South Korea
Department of Neurology, LAU Medical Center-Rizk Hospital, Beirut, Lebanon
Department of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
University Putra Malaysia, Malaysia
Sarawak General Hospital, Kuching, Malaysia
Hospital Sultan Abdul Halim, Sungai Petani Kedah, Malaysia
Hospital Seberang Jaya, Pulau Pinang, Malaysia
Thomson Hospital Kota Damansara, Malaysia
“Nicolae Testemitanu” State University of Medicine and Pharmacy, Department of Neurology, Emergency Medicine Institute, Chisinau, Moldova
Department of Stroke Unit, Royal Hospital Muscat, Oman
Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
St. Luke’s Medical Center-Institute of Neurosciences, Quezon City, Philippines
Endovascular Neurosurgery, Saint-Petersburg Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russian Federation
Department of Neurology, Stroke Unit, King Saud University, College of Medicine, Riyadh, Saudi Arabia
Department of Neurosurgery, Interventional Radiology, and Critical Care Medicine, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Saudi Arabia
Singapore National Neuroscience Institute, Singapore, Singapore
Changi General Hospital, Singapore, Singapore
Neuroscience Center, Raffles Hospital, Singapore, Singapore
Department of Neurology, National Taiwan University Hospital, Taiwan
Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Dicle University Medical School and Hospital, Diyarbakir, Turkey
Stroke and Neurointervention Unit, Eskisehir Osmangazi University, Turkey
Gaziantep University Faculty of Medicine, Turkey
Department of Neurology, Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
Stroke Center, Hue Central Hospital, Hue, Viet Nam
Stroke Department, Da Nang Hospital, Da Nang City, Viet Nam
115 People’s Hospital, Ho Chi Minh City, Viet Nam
Department of Neurology, Medical University of Graz, Austria
Department of Neurology, Research Institute of Neurointervention, University Hospital Salzburg, Paracelsus Medical University, Austria
Department of Neurology, Centre Hospitalier Universitaire de Charleroi, Belgium
Department of Neurology, Sint Jan Hospital, Bruges, Belgium
Department of Neurology, Brussels University Hospital (UZ Brussel), Belgium
Department of Neurology, ULB Erasme Hospitals Brussels, Belgium
Department of Neurology, Europe Hospitals Brussels, Belgium
Department of Neurology, Antwerp University Hospital, Belgium
Neurology Clinic, St. Anna University Hospital, Sofia, Bulgaria
Department of Neurology, Sestre Milosrdnice University Hospital, Zagreb, Croatia
Department of Neurology, Sveti Duh University Hospital, Zagreb, Croatia
Department of Neurology, General Hospital Virovitica, Croatia
Department of Neurology, General Hospital Zabok, Croatia
Department of Radiology, University Hospital Centre Zagreb, Croatia
Regional Hospital Karlovy Vary, Czech Republic
Masaryk Hospital Usti nad Labem, Czech Republic
Military University Hospital Praha, Czech Republic
Oblastní Nemocnice Náchod, Czech Republic
Regional Hospital Pribram, Czech Republic
Municipal Hospital Ostrava, Czech Republic
Hospital Mlada Boleslav, Czech Republic
Hospital Vitkovice, Czech Republic
Hospital Jihlava, Czech Republic
General University Hospital Praha, Czech Republic
Hospital Litomysl, Czech Republic
Hospital České Budejovice, Czech Republic
Hospital Pisek, Czech Republic
Hospital Uherske Hradiste, Czech Republic
Hospital Prostejov, Czech Republic
Regional Hospital Chomutov, Czech Republic
Hospital Teplice, Czech Republic
Mining Hospital Karvina, Czech Republic
Thomayer Hospital Praha, Czech Republic
Hospital Blansko, Czech Republic
University Hospital Brno, Czech Republic
Regional Hospital Liberec, Czech Republic
Hospital Ceska Lipa, Czech Republic
Hospital Sokolov, Czech Republic
Regional Hospital Kolin, Czech Republic
Hospital Trutnov, Czech Republic
Hospital Trinec, Czech Republic
Department of Neurology, University Hospital Ostrava, Faculty of Medicine, Masaryk University, Brno, Czech Republic
Bispebjerg Hospital, University of Copenhagen, Denmark
Stroke Center, Rigshospitalet, University of Copenhagen, Denmark
Aarhus University Hospital, Aarhus, Denmark
Neurovascular Center, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
Neurology Clinic, West Tallinn Central Hospital, Estonia
Center of Neurology, East Tallinn Central Hospital, School of Natural Sciences and Health, Tallinn University, Estonia
Internal Medicine Clinic, Pärnu Hospital, Estonia
Université Lille, Inserm, CHU Lille, Lille Neuroscience and Cognition, France
Centre Hospitalier d’Arcachon, Gujan-Mestras, France
Centre Hospitalier d’Agen, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Bron, France
Neurologie Vasculaire, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Bron, France
Neuroradiologie, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Bron, France
Centre Hospitalier, Universitaire de Bordeaux, France
Centre Hospitalier de Mont de Marsan, France
Neurologie, Fondation Ophtalmologique Adolphe de Rothschild, France
Versailles Saint-Quentin-en-Yvelines University, France
Neuroradiologie Interventionelle, Fondation Ophtalmologique Adolphe de Rothschild, France
Neuroradiologie Interventionelle, Hôpitaux Universitaires de Strasbourg, France
K. Eristavi National Center of Experimental and Clinical Surgery, Tbilisi, Georgia
Department of Neurosurgery, New Vision University Hospital, Tbilisi, Georgia
Vivamedi Medical Center, Tbilisi, Georgia
Pineo Medical Ecosystem, Tbilisi, Georgia
Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
Department of Neurology, University Hospital Heidelberg, Germany
Department of Neurology, Albertinen Krankenhaus, Hamburg, Germany
Department of Neurology, Elbe Klinken Stade, University Medical Center Göttingen, Germany
Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
Department of Neurology, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Germany
Department of Internal Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
Second Department of Neurology, Stroke Unit, Metropolitan Hospital, Piraeus, Greece
University of Szeged, Szeged, Hungary
University of Pecs, Hungary
Stroke Center, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico, Negrar, Verona, Italy
Department of Neurology, Ospedale San Paolo, Savona, Italy
Institute of Neurology, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
Interventional Neurovascular Unit, Careggi University Hospital, Florence, Italy
Stroke Unit, Azienda Socio Sanitaria Territoriale (ASST), Lecco, Italy
Department of Neurology, Radiology, University Medical Center Groningen, Netherlands
Department of Neurology, Haaglanden Medical Center, the Hague, Netherlands
Department of Neurology, Akershus University Hospital, Lørenskog, Norway
HELSAM, University of Oslo, Norway
Neurological Ward with Stroke Unit, Specialist Hospital in Konskie, Gimnazjalna, Poland
Collegium Medicum, Jan Kochanowski University, Kielce, Poland
Neurological Ward with Stroke Unit, District Hospital, Skarzysko-Kamienna, Poland
Department of Neurology, Szpitala im T. Marciniaka, Wroclaw, Poland
2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, Poland
107th Military Hospital with Polyclinic, Walcz, Poland
Department of Neurology, St. Queen Jadwiga, Clinical Regional Hospital No. 2, Rzeszow, Poland
Department of Neurology, Medical University of Lublin, Poland
1st Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
Department of Neurology, Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Collegium Medicum Jan Kochanowski University, Kielce, Poland
Copernicus PL, Neurology and Stroke Department, Hospital M. Kopernik, Gdansk, Poland
Stroke Unit, Neurological Department, Stanislaw Staszic University of Applied Sciences, Pila, Poland
Hospital São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
Stroke Unit, Hospital Pedro Hispano, Matosinhos, Portugal
Stroke Unit, Internal Medicine Department, Neuroradiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
Department of Neurosciences, Hospital de Santa Maria-CHLN, North Lisbon University Hospital, Lisbon, Portugal
Department of Neurology, Hospital Garcia de Orta, Portugal
Department of Neurology, Transilvania University, Brasov, Romania
Department of Neurology, Faculty Hospital Trnava, Slovakia
Department ofNeurology and Stroke Center, Hospital Universitario La Paz, Madrid, Spain
Department of Neurology, Hospital Clínico Universitario, Universidad de Valladolid, Spain
Department of Neurology, Complejo Hospitalario Universitario de Albacete, Spain
Department of Neurology, Unidad de Ictus, Hospital Universitario Ramon y Cajal, Madrid, Spain
Department of Neurology, Hospital Universitario Virgen Macarena, Spain
Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IbiS, Spain
Rio Hortega University Hospital, University of Valladolid, Spain
Cerebrovascular Diseases, Hospital Clinic of Barcelona, Spain
Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
Department of Interventional Neuroradiology, University Hospitals of Geneva, Switzerland
Department of Interventional and Diagnostic Neuroradiology, Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
Department of Neurology, University of Bern, Switzerland
Department of Neuroradiology, University of Bern, Switzerland
Department of Neuroscience, Lausanne University Hospital, Switzerland
Department of Stroke Medicine, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
Department of Neurology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, United Kingdom
Department of Neurology, University of Alberta, Edmonton, Canada
Department of Neurology, McMaster University, Hamilton, Canada
Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Canada
Department of Neurology, University of British Columbia, Vancouver, Canada
Mackenzie Health, Richmond Hill, ON, Canada
Department of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
Department of Neurology, Hopital Enfant Jesus, Centre Hospitalier, Universite Laval, Quebec City, Canada
Department of Neurology, University of Toronto, Canada
Medicine, St. Michael’s Hospital, University of Toronto, Canada
Department of Neurosciences, Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica
Neurovascular Service, Hospital General San Juan de Dios, Guatemala City, Guatemala
Department of Neurología, Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social, Guatemala City, Guatemala
Department of Neurology, University Hospital Jose Eleuterio Gonzalez, Universidad Autonoma de Nuevo Leon, Mexico
Pacífica Salud-Hospital Punta Pacífica, Panama
Department of Neurology, Radiology, University of Kansas Medical Center, United States
Department of Neurointerventional Neurosurgery, Valley Baptist Hospital, Ridgewood, NJ, United States
Palmetto General Hospital, Tenet, FL, United States
Neurology, University Hospital Newark, New Jersey Medical School, Rutgers, Newark, NJ, United States
Community Healthcare System, Munster, IN, United States
Department of Neurology, California Pacific Medical Center, San Francisco, United States
Department of Neurology, Mount Sinai South Nassau, New York, United States
University of Toledo, OH, United States
Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
Neuroscience, Inova Fairfax Hospital, VA, United States
Department of Neurology, Abington Jefferson Hospital, PA, United States
Baptist Health Medical Center, Little Rock, AR, United States
Department of Neurology, HCA Houston Healthcare Clearlake, TX, United States
Department of Neurology, Erlanger, TN, United States
Wilmington, NC, United States
Department of Vascular and Neurointerventional Services, St. Louis University, MO, United States
Department of Neurology, Massachusetts General Hospital, Boston, United States
Department of Neurology, Neurosurgery, and Radiology, University of Iowa Hospitals and Clinics, Iowa City, United States
Department of Radiology, Swedish Medical Center, Englewood, CO, United States
Department of Radiology, Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
Adventist Health Glendale Comprehensive Stroke Center, Los Angeles, CA, United States
Wellstar Neuroscience Institute, Marietta, GA, United States
Department of Neurology, University of Texas Rio Grande Valley-Valley Baptist Medical Center, TX, United States
Department of Neurology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, United States
Department of Neurology, Wayne State, Detroit, MI, United States
HSHS St. John’s Hospital, Southern Illinois University School of Medicine, Springfield, United States
Virginia Hospital Center, Arlington, United States
Weill-Cornell Medical College, New York-Presbyterian Queens, United States
Department of Neurology, Ohio State University, Columbus, United States
Department of Neurology, Tufts Medical Center, Boston, MA, United States
Vascular and Neurointerventional Services, St. Louis University, MO, United States
Miami Cardiac and Vascular Institute, FL, United States
Department of Neurology, Oregon Health and Science University, Portland, United States
Department of Emergency Medicine, Steward Holy Family Hospital, Methuen, MA, United States
Vidant Medical Center, Greenville, NC, United States
Department of Neurology, University of Miami Miller School of Medicine, FL, United States
Department of Neurosurgery, University of Miami Miller School of Medicine, FL, United States
Department of Neurology, SUNY Upstate New York, Syracuse, United States
Memorial Neuroscience Institute, Pembroke Pines, FL, United States
Neurosciences, Spectrum Health, Michigan State University College of Medicine, Grand Rapids, MI, United States
Sutter Health, Sacramento, CA, United States
Department of Neurology, MaineMedical Center, Portland, United States
Department of Neurology, Bayhealth, Dover, DE, United States
Department of Neurology and Pediatrics, Emory University, Atlanta, GA, United States
Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, United States
Department of Radiology and Neurology, UT Southwestern Medical Center, Dallas, TX, United States
Ascension St. John Medical Center, Tulsa, OK, United States
Riverside Regional Medical Center, Newport, VA, United States
Department of Neurology, Boston University School of Medicine, MA, United States
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, United States
Department of Neurology, University of Washington School Medicine, Seattle, United States
Department of Neurology, University of Massachusetts Medical Center, Worcester, United States
Department of Neurology, CHI-Immanuel Neurological Institute, Creighton University, Omaha, NE, United States
Holy Cross Hospital, Fort Lauderdale, FL, United States
Department of Neurology, Interventional Neuroradiology, University of California, Los Angeles, United States
Banner Desert Medical Center, Mesa, AZ, United States
Hospital de Agudos Dr. Ignacio Privano, Argentina
Institute for Neurological Research, FLENI, Buenos Aires, Argentina
Hospital das Clinicas, São Paulo University, Brazil
Sumare State Hospital, São Paulo, Brazil
Hospital Vera Cruz, Deus Campinas, Brazil
Irmanandade Santa Casa de Porto Alegre, Brazil
Stroke Unit, Hospital Geral de Fortaleza, Brazil
Stroke Unit, Hospital Sao Jose, Joinville, Santa Catarina, Brazil
Stroke Unit, Neurology, Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil
Department of Neurology, Hospital Moinhos de Vento, Porto Alegre, Brazil
Department of Neurology, Hospital de Base do Distrito Federal, Brazil
Hospital Ana, Hospital Juliane, Federal University of Parana, Curitiba, Brazil
Vascular Neurology Unit, Neurology Service, Department of Neurology and Psychiatry, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
Hospital Padre Hurtado, Santiago, Chile
Fundación Valle del Lili, Cali, Colombia
Stroke Center, Fundación Santa Fe de Bogotá, Colombia
Clinica Universitaria Colombia, Bogotá, Colombia
University Hospital of San Vicente Foundation, Medellin, Colombia
Barranquilla, Colombia
Hospital Infantil Universitario de San Jose, Bogota, Colombia
Stroke Unit, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Colombia
Neurology Service, Hospital Central del Instituto de Prevision Social, Colombia
Internal Medicine Service, Hospital Central de Policia “Rigoberto Caballero”, Colombia
National Institute of Neurological Sciences, Lima, Peru
Hospital Edgardo Rebagliati Martins, Lima, Peru
Department of Neurology, Royal Melbourne Hospital, Australia
Department of Neurology, Sir Charles Gairdner Hospital and Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
University of Melbourne, Ballarat Health Service, Australia University of Melbourne, Australia
Department of Neurology, Royal Adelaide Hospital, Australia
Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia
Department of Neurology, Mater Hospital, Brisbane, Australia
Department of Neurology, Austin Health, VIC, Australia
Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
Greymouth Base Hospital, New Zealand
Department of Neurology, Christchurch Hospital, New Zealand
Department of Neurology, University of California, Los Angeles, United States
Department of Neurology, Mercy Health Neurosciences, Toledo, OH, United States

Department of Neurology
Department of Radiology
Radiation Oncology
Department of Neurology
Hospital de Clínicas de Porto Alegre
Department of Stroke Neurology
Department of Neurology
Department of Neurology
Boston University School of Medicine
2nd Department of Neurology
Department of Neurology
Faculdade de Medicina
Department of Neurology
International Clinical Research Center
Department of Neurology
Department of Neurology
Department of Translational Neuroscience
Department of Neurology
Department of Neurology and Neurosurgery
Department of Neurology
Department of Neurosurgery
Department of Neurology
Department of Neurology
Department of Neurology
Department of Internal Medicine
Department of Neurology
Department of Neurology
Department of Medicine and Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Radiology
Douala Gynaeco-Obstetric and Pediatric Hospital
Ain Shams University Specialized Hospital
Cairo University Affiliated MOH Network
Department of Neurology
Mansoura University Affiliated Private Hospitals Network
Kwame Nkrumah University of Science and Technology
Stroke Unit
Neurology Unit
Department of Medicine
Neurology Unit
University College Hospital
National Ribat University Affiliated Hospitals
Neurology Section
Tunis El Manar University
Department of Neurology
Department of Physiology
Department of Physiology and Medicine
Department of Cerebrovascular
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology and Neuroscience
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Acute Stroke Unit
Interventional Neurology
NH Institute of Neurosciences
Department of Neurology
Department of Neurology
Sree Chitra Tirunal Institute for Medical Sciences and Technology
Stroke Unit
Neurosciences Research Center
Beer Sheva Hospital
Department of Interventional Neuroradiology
Department of Neurology
Department of Neurosurgery
Department of Stroke and Neurovascular Surgery
Yokohama Brain and Spine Center
Iwate Prefectural Central
Department of Neurology and Stroke Treatment
Department of Neurology
Department of Neurology
Department of Stroke Neurology
Department of Cerebrovascular Medicine
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Cerebrovascular Medicine
Department of Neurology
Stroke Medicine
Department of Neurology
Department of Stroke Prevention and Treatment
Department of Neurology
Department of Neurology
Department of Cerebrovascular Medicine
Department of Neurology and Neuroendovascular Treatment
Department of Neurology
Department of Neurology
Department of Advanced Brain Research
Department of Neurology
Department of Neurology
Division of Stroke
Department of Comprehensive Stroke
Department of Neurology
Republican Center for eHealth
Department of Medicine
Kazakh-Russian Medical University
Department of Neurology
Department of Neurology
Ajou University Hospital
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Asan Medical Center
Department of Neurology
Department of Medicine
Sultanah Nur Zahirah
University Putra Malaysia
Sarawak General Hospital
Hospital Sultan Abdul Halim
Hospital Seberang Jaya
Thomson Hospital Kota Damansara
“Nicolae Testemitanu” State University of Medicine and Pharmacy
Department of Stroke Unit
Neuroscience Institute
St. Luke’s Medical Center-Institute of Neurosciences
Endovascular Neurosurgery
Department of Neurology
Department of Neurosurgery
Singapore National Neuroscience Institute
Changi General Hospital
Neuroscience Center
Department of Neurology
Department of Radiology
Dicle University Medical School and Hospital
Stroke and Neurointervention Unit
Gaziantep University Faculty of Medicine
Department of Neurology
Stroke Center
Stroke Department
115 People’s Hospital
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Neurology Clinic
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Radiology
Regional Hospital Karlovy Vary
Masaryk Hospital Usti nad Labem
Military University Hospital Praha
Oblastní Nemocnice Náchod
Regional Hospital Pribram
Municipal Hospital Ostrava
Hospital Mlada Boleslav
Hospital Vitkovice
Hospital Jihlava
General University Hospital Praha
Hospital Litomysl
Hospital České Budejovice
Hospital Pisek
Hospital Uherske Hradiste
Hospital Prostejov
Regional Hospital Chomutov
Hospital Teplice
Mining Hospital Karvina
Thomayer Hospital Praha
Hospital Blansko
University Hospital Brno
Regional Hospital Liberec
Hospital Ceska Lipa
Hospital Sokolov
Regional Hospital Kolin
Hospital Trutnov
Hospital Trinec
Department of Neurology
Bispebjerg Hospital
Stroke Center
Aarhus University Hospital
Neurovascular Center
Neurology Clinic
Center of Neurology
Internal Medicine Clinic
Université Lille
Centre Hospitalier d’Arcachon
Centre Hospitalier d’Agen
Neurologie Vasculaire
Neuroradiologie
Centre Hospitalier
Centre Hospitalier de Mont de Marsan
Neurologie
Versailles Saint-Quentin-en-Yvelines University
Neuroradiologie Interventionelle
Neuroradiologie Interventionelle
K. Eristavi National Center of Experimental and Clinical Surgery
Department of Neurosurgery
Vivamedi Medical Center
Pineo Medical Ecosystem
Ivane Javakhishvili Tbilisi State University
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Klinik und Poliklinik für Neurologie
Department of Internal Medicine
Second Department of Neurology
University of Szeged
University of Pecs
Stroke Center
Department of Neurology
Institute of Neurology
Interventional Neurovascular Unit
Stroke Unit
Department of Neurology
Department of Neurology
Department of Neurology
HELSAM
Neurological Ward with Stroke Unit
Collegium Medicum
Neurological Ward with Stroke Unit
Department of Neurology
2nd Department of Neurology
Department of Neurology and Cerebrovascular Disorders
107th Military Hospital with Polyclinic
Department of Neurology
Department of Neurology
1st Department of Neurology
Department of Neurology
Copernicus PL
Stroke Unit
Hospital São José
Stroke Unit
Stroke Unit
Department of Neurology
Department of Neurosciences
Department of Neurology
Department of Neurology
Department of Neurology
Department ofNeurology and Stroke Center
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Neurovascular Research Laboratory
Rio Hortega University Hospital
Cerebrovascular Diseases
Department of Neurology
Department of Interventional Neuroradiology
Department of Interventional and Diagnostic Neuroradiology
Department of Neurology
Department of Neuroradiology
Department of Neuroscience
Department of Stroke Medicine
Department of Neurology
Department of Neurology
Department of Neurology
Department of Clinical Neurosciences
Department of Neurology
Mackenzie Health
Department of Neurology
Department of Neurology
Department of Neurology
Medicine
Department of Neurosciences
Neurovascular Service
Department of Neurología
Department of Neurology
Pacífica Salud-Hospital Punta Pacífica
Department of Neurology
Department of Neurointerventional Neurosurgery
Palmetto General Hospital
Neurology
Community Healthcare System
Department of Neurology
Department of Neurology
University of Toledo
Department of Neurology
Neuroscience
Department of Neurology
Baptist Health Medical Center
Department of Neurology
Department of Neurology
Wilmington
Department of Vascular and Neurointerventional Services
Department of Neurology
Department of Neurology
Department of Radiology
Department of Radiology
Adventist Health Glendale Comprehensive Stroke Center
Wellstar Neuroscience Institute
Department of Neurology
Department of Neurology
Department of Neurology
HSHS St. John’s Hospital
Virginia Hospital Center
Weill-Cornell Medical College
Department of Neurology
Department of Neurology
Vascular and Neurointerventional Services
Miami Cardiac and Vascular Institute
Department of Neurology
Department of Emergency Medicine
Vidant Medical Center
Department of Neurology
Department of Neurosurgery
Department of Neurology
Memorial Neuroscience Institute
Neurosciences
Sutter Health
Department of Neurology
Department of Neurology
Department of Neurology and Pediatrics
Department of Neurology
Department of Radiology and Neurology
Ascension St. John Medical Center
Riverside Regional Medical Center
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Department of Neurology
Holy Cross Hospital
Department of Neurology
Banner Desert Medical Center
Hospital de Agudos Dr. Ignacio Privano
Institute for Neurological Research
Hospital das Clinicas
Sumare State Hospital
Hospital Vera Cruz
Irmanandade Santa Casa de Porto Alegre
Stroke Unit
Stroke Unit
Stroke Unit
Department of Neurology
Department of Neurology
Hospital Ana
Vascular Neurology Unit
Hospital Padre Hurtado
Fundación Valle del Lili
Stroke Center
Clinica Universitaria Colombia
University Hospital of San Vicente Foundation
Barranquilla
Hospital Infantil Universitario de San Jose
Stroke Unit
Neurology Service
Internal Medicine Service
National Institute of Neurological Sciences
Hospital Edgardo Rebagliati Martins
Department of Neurology
Department of Neurology
University of Melbourne
Department of Neurology
Department of Neurosurgery
Department of Neurology
Department of Neurology
Florey Institute of Neuroscience and Mental Health
Greymouth Base Hospital
Department of Neurology
Department of Neurology
Department of Neurology

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