<h3>Background and Objectives</h3> Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). <h3>Methods</h3> We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their <i>ICD-10</i> codes or classifications in stroke databases. <h3>Results</h3> There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1–6.9]; <i>p</i> &lt; 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1–4.6]; <i>p</i> &lt; 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4–5.8]; <i>p</i> &lt; 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all <i>p</i> &lt; 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6–0.9]; <i>p</i> = 0.49). Stroke was diagnosed in 1.3% [1.31–1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82–2.97], 5,656/195,539) of all stroke hospitalizations. <h3>Discussion</h3> There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year. <h3>Trial Registration Information</h3> This study is registered under NCT04934020.