Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE)

Shahram Abootalebi, Benjamin M. Aertker, Mohammad Sobhan Andalibi, Negar Asdaghi, Ozlem Aykac, M. Reza Azarpazhooh*, M. Cecilia Bahit, Kristian Barlinn, Hamidon Basri, Reza Bavarsad Shahripour, Anna Bersano, Jose Biller, Afshin Borhani-Haghighi, Robert D. Brown, Bruce CV Campbell, Salvador Cruz-Flores, Deidre Anne De Silva, Mario Di Napoli*, Afshin A. Divani, Randall C. EdgellJohanna T. Fifi, Abdoreza Ghoreishi, Teruyuki Hirano, Keun Sik Hong, Chung Y. Hsu, Josephine F. Huang, Manabu Inoue, Amanda L. Jagolino, Moira Kapral, Hoo Fan Kee, Zafer Keser, Rakesh Khatri, Masatoshi Koga, Jerzy Krupinski, David S. Liebeskind, Liping Liu, Henry Ma, Alberto Maud, Louise D. McCullough, Dawn Matherne Meyer, Victoria Mifsud, Negar Morovatdar, Yongchai Nilanont, Thomas J. Oxley, Atilla Özcan Özdemir, Jeyaraj Pandian, Leonardo Pantoni, Nikolaos I.H. Papamitsakis, Adrian Parry-Jones, Thanh Phan, Gustavo Rodriguez, Jose G. Romano, Ziad Sabaa-Ayoun, Hamidreza Saber, Payam Sasannezhad, Jeffrey L. Saver, Eugene Scharf, Ashfaq Shuaib, Brian Silver, Shaloo Singhal, Craig J. Smith, Saverio Stranges, P. N. Sylaja, Michel Torbey, Kazunori Toyoda, Georgios Tsivgoulis, Mohammad Wasay, Nawaf Yassi, Takeshi Yoshimoto, Babak Zamani, Ramin Zand

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

24 Citations (Scopus)


Background and purpose: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic. Methods: This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center. Conclusion: The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.

Original languageEnglish
Article number104938
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number9
Publication statusPublished - Sept 2020


  • COVID-19
  • Health policy
  • Incidence
  • Mortality
  • National crisis
  • Pandemic
  • SARS-CoV-2
  • Stroke


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