Introduction Coronavirus disease 2019 (COVID-19), a contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide. The literature evaluating treating patients diagnosed with intracranial aneurysms during the COVID era is limited. To investigate the impact of COVID-19 on the overall complication rate, including ischemic stroke and subarachnoid hemorrhage rates in patients treated using an endovascular or open surgical approach for intracranial aneurysms (ICAs) using the National Inpatient Sample (NIS).

Methods This national, multicenter, retrospective cohort study included patients diagnosed and treated for ICAs from January 2016 to December 2020. A total of 57,715 admissions were identified. Of these, 45,979 occurred pre-COVID and 11,736 during the COVID period. The main outcome was an ischemic stroke, subarachnoid hemorrhage (SAH), death, non-routine discharge total charges (in US dollars), and length of stay (in days). Outcomes were compared pre- and post-COVID using piecewise joinpoint regression with the Mann-Kendall test. In addition, a 1:1 propensity score matching protocol was applied using a nearest-neighbor approach with replacement to address confounding by indication and to evaluate adjusted comparisons in clinical endpoints between the pre- and during the COVID period.

Results The mean age was 65 years, with most of the patients being females (32,134; 69.9%). Endovascular treatments were performed in 7,759 (82.9%) pre-COVID admissions compared to 1,473 (82.4%) during the COVID period, while surgical treatment was performed in 1,600 (17.1%) pre-COVID patients compared to 314 (17.6%) during COVID. In addition, the mean total charges were higher during the pandemic. ($120,067.463±157,775.6 vs. $98,045.712±142,479.9; p<0.001). There was no difference in treatment type for ICAs (p=0.776), SAH (p=0.227), or length of stay (p=0.266) during the pandemic; however, the overall complication rate was higher (31.1%; p<0.001) compared to the pre-COVID period. There was a significant increase in hospitalizations for ischemic stroke in patients treated for ICA (6.1% to 7.9%; p=0.04), but no trend was observed for SAH or death (p=0.31). Higher odds of ischemic stroke among ICA patients were found during COVID (OR 1.13; 95% CI 1.05 to 1.22; p=0.03); however, these patients had similar odds of SAH during the pandemic (OR 0.97; 95% CI 0.88 to 1.06; p=0.89).

Conclusions and Relevance The COVID-19 pandemic has significantly impacted the healthcare system and has led to changes in the treatment of various neurological conditions, including ICAs. The pandemic resulted in a shift in the treatment of SAH and an increase in endovascular procedures over open surgical clipping. COVID-19 infection has been associated with an increased risk of ischemic stroke and worsened outcomes for stroke patients. Further research is necessary to understand the long-term effects of the pandemic on the healthcare system and patient outcomes.

Disclosures A. Ghaith: None. M. Ghanem: None. E. Greco: None. J. Rios-Zermeno: None. A. Bon Nieves: None. S. Kashyap: None. R. Tawk: None. M. Bydon: None.