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The authors evaluated patients with ischemic stroke treated with mechanical thrombectomy (MT) over 45 days during the COVID-19 outbreak and over the same time period in 2019 to evaluate the effect of epidemic containment measures on the provision of care. There was a 21% decrease in the MT case volume from 2019 to 2020. In addition, there were significant delays between imaging and groin puncture during the epidemic period. There was a significant negative correlation between the rate of hospitalizations for COVID-19 and the number of MT cases.
Epidemic containment measures were associated with a significant and alarming decrease in the number of patients treated with MT and delays in accessing care. Further work is needed to prepare local and regional stroke networks for adequate provision of care as the COVID-19 pandemic evolves.
This abstract is available on the publisher's site.
The efficiency of prehospital care chain response and the adequacy of hospital resources are challenged amid the coronavirus disease 2019 (COVID-19) outbreak, with suspected consequences for patients with ischemic stroke eligible for mechanical thrombectomy (MT).
We conducted a prospective national-level data collection of patients treated with MT, ranging 45 days across epidemic containment measures instatement, and of patients treated during the same calendar period in 2019. The primary end point was the variation of patients receiving MT during the epidemic period. Secondary end points included care delays between onset, imaging, and groin puncture. To analyze the primary end point, we used a Poisson regression model. We then analyzed the correlation between the number of MTs and the number of COVID-19 cases hospitalizations, using the Pearson correlation coefficient (compared with the null value).
A total of 1513 patients were included at 32 centers, in all French administrative regions. There was a 21% significant decrease (0.79; [95%CI, 0.76-0.82]; P<0.001) in MT case volumes during the epidemic period, and a significant increase in delays between imaging and groin puncture, overall (mean 144.9±SD 86.8 minutes versus 126.2±70.9; P<0.001 in 2019) and in transferred patients (mean 182.6±SD 82.0 minutes versus 153.25±67; P<0.001). After the instatement of strict epidemic mitigation measures, there was a significant negative correlation between the number of hospitalizations for COVID and the number of MT cases (R2 -0.51; P=0.04). Patients treated during the COVID outbreak were less likely to receive intravenous thrombolysis and to have unwitnessed strokes (both P<0.05).
Our study showed a significant decrease in patients treated with MTs during the first stages of the COVID epidemic in France and alarming indicators of lengthened care delays. These findings prompt immediate consideration of local and regional stroke networks preparedness in the varying contexts of COVID-19 pandemic evolution.
Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak: Decreased Activity, and Increased Care Delays
Stroke 2020 May 20;[EPub Ahead of Print], B Kerleroux, T Fabacher, N Bricout, M Moïse, B Testud, S Vingadassalom, H Ifergan, K Janot, A Consoli, W Ben Hassen, E Shotar, J Ognard, G Charbonnier, V L'Allinec, A Guédon, F Bolognini, G Marnat, G Forestier, A Rouchaud, R Pop, N Raynaud, F Zhu, J Cortese, V Chalumeau, J Berge, S Escalard, G Boulouis