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1.
J Neurointerv Surg ; 13(12): 1088-1094, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1526521

ABSTRACT

BACKGROUND: The optimal anesthesia management for patients with stroke undergoing mechanical thrombectomy (MT) during the COVID-19 pandemic has become a matter of controversy. Some recent guidelines have favored general anesthesia (GA) in patients perceived as high risk for intraprocedural conversion from sedation to GA, including those with dominant hemispheric occlusions/aphasia or baseline National Institutes of Health Stroke Scale (NIHSS) score >15. We aim to identify the rate and predictors of conversion to GA during MT in a high-volume center where monitored anesthesia care (MAC) is the default modality. METHODS: A retrospective review of a prospectively maintained MT database from January 2013 to July 2020 was undertaken. Analyses were conducted to identify the predictors of intraprocedural conversion to GA. In addition, we analyzed the GA conversion rates in subgroups of interest. RESULTS: Among 1919 MT patients, 1681 (87.6%) started treatment under MAC (median age 65 years (IQR 55-76); baseline NIHSS 16 (IQR 11-21); 48.4% women). Of the 1677 eligible patients, 26 (1.6%) converted to GA including 1.4% (22/1615) with anterior and 6.5% (4/62) with posterior circulation strokes. The only predictor of GA conversion was posterior circulation stroke (OR 4.99, 95% CI 1.67 to 14.96, P=0.004). The conversion rates were numerically higher in right than in left hemispheric occlusions (1.6% vs 1.2%; OR 1.37, 95% CI 0.59 to 3.19, P=0.47) and in milder than in more severe strokes (NIHSS ≤15 vs >15: 2% vs 1.2%; OR 0.62, 95% CI 0.28 to 1.36, P=0.23). CONCLUSIONS: Our study showed that the overall rate of conversion from MAC to GA during MT was low (1.6%) and, while higher in posterior circulation strokes, it was not predicted by either hemispheric dominance or stroke severity. Caution should be given before changing clinical practice during moments of crisis.


Subject(s)
Brain Ischemia , COVID-19 , Stroke , Aged , Anesthesia, General/adverse effects , Brain Ischemia/surgery , Female , Humans , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , Stroke/surgery , Thrombectomy , Treatment Outcome , United States
2.
J Neurointerv Surg ; 13(12): 1088-1094, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1043454

ABSTRACT

BACKGROUND: The optimal anesthesia management for patients with stroke undergoing mechanical thrombectomy (MT) during the COVID-19 pandemic has become a matter of controversy. Some recent guidelines have favored general anesthesia (GA) in patients perceived as high risk for intraprocedural conversion from sedation to GA, including those with dominant hemispheric occlusions/aphasia or baseline National Institutes of Health Stroke Scale (NIHSS) score >15. We aim to identify the rate and predictors of conversion to GA during MT in a high-volume center where monitored anesthesia care (MAC) is the default modality. METHODS: A retrospective review of a prospectively maintained MT database from January 2013 to July 2020 was undertaken. Analyses were conducted to identify the predictors of intraprocedural conversion to GA. In addition, we analyzed the GA conversion rates in subgroups of interest. RESULTS: Among 1919 MT patients, 1681 (87.6%) started treatment under MAC (median age 65 years (IQR 55-76); baseline NIHSS 16 (IQR 11-21); 48.4% women). Of the 1677 eligible patients, 26 (1.6%) converted to GA including 1.4% (22/1615) with anterior and 6.5% (4/62) with posterior circulation strokes. The only predictor of GA conversion was posterior circulation stroke (OR 4.99, 95% CI 1.67 to 14.96, P=0.004). The conversion rates were numerically higher in right than in left hemispheric occlusions (1.6% vs 1.2%; OR 1.37, 95% CI 0.59 to 3.19, P=0.47) and in milder than in more severe strokes (NIHSS ≤15 vs >15: 2% vs 1.2%; OR 0.62, 95% CI 0.28 to 1.36, P=0.23). CONCLUSIONS: Our study showed that the overall rate of conversion from MAC to GA during MT was low (1.6%) and, while higher in posterior circulation strokes, it was not predicted by either hemispheric dominance or stroke severity. Caution should be given before changing clinical practice during moments of crisis.


Subject(s)
Brain Ischemia , COVID-19 , Stroke , Aged , Anesthesia, General/adverse effects , Brain Ischemia/surgery , Female , Humans , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , Stroke/surgery , Thrombectomy , Treatment Outcome , United States
3.
Cerebrovasc Dis ; 50(2): 178-184, 2021.
Article in English | MEDLINE | ID: covidwho-975760

ABSTRACT

INTRODUCTION: We examined the impact of the coronavirus disease 2019 (COVID-19) pandemic on our regional stroke thrombectomy service in the UK. METHODS: This was a single-center health service evaluation. We began testing for COVID-19 on 3 March and introduced a modified "COVID Stroke Thrombectomy Pathway" on 18 March. We analyzed the clinical, procedural and outcome data for 61 consecutive stroke thrombectomy patients between 1 January and 30 April. We compared the data for January and February ("pre-COVID," n = 33) versus March and April ("during COVID," n = 28). RESULTS: Patient demographics were similar between the 2 groups (mean age 71 ± 12.8 years, 39% female). During the COVID-19 pandemic, (a) total stroke admissions fell by 17% but the thrombectomy rate was maintained at 20% of ischemic strokes; (b) successful recanalization rate was maintained at 81%; (c) early neurological outcomes (neurological improvement following thrombectomy and inpatient mortality) were not significantly different; (d) use of general anesthesia fell significantly from 85 to 32% as intended; and (e) time intervals from onset to arrival, groin puncture, and recanalization were not significantly different, whereas internal delays for external referrals significantly improved for door-to-groin puncture (48 [interquartile range (IQR) 39-57] vs. 33 [IQR 27-44] minutes, p = 0.013) and door-to-recanalization (82.5 [IQR 61-110] vs. 60 [IQR 55-70] minutes, p = 0.018). CONCLUSION: The COVID-19 pandemic has had a negative impact on the stroke admission numbers but not stroke thrombectomy rate, successful recanalization rate, or early neurological outcome. Internal delays actually improved during the COVID-19 pandemic. Further studies should examine the effects of the COVID-19 pandemic on longer term outcome.


Subject(s)
Brain Ischemia/surgery , COVID-19/complications , Stroke/surgery , Thrombectomy , Thrombolytic Therapy , Aged , Aged, 80 and over , Brain Ischemia/epidemiology , COVID-19/surgery , COVID-19 Testing , Female , Hospitalization , Humans , Male , Middle Aged , SARS-CoV-2 , Stroke/mortality , Thrombectomy/methods , Time-to-Treatment , United Kingdom
4.
Curr Opin Neurol ; 34(1): 18-21, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-940813

ABSTRACT

PURPOSE OF REVIEW: The aim of this article is to review the current literature on endovascular treatment of acute ischemic stroke in the aftermath of the coronavirus disease 2019 (COVID-19) lockdown. RECENT FINDINGS: The outbreak of the COVID-19 has had effect of unprecedented magnitude on the social, economic and personal aspects around the globe. Healthcare providers were forced to expand capacity to provide care to the surging number of symptomatic COVID-19 patients, while maintaining a fully operating service for all non-COVID patients. The recent literature suggesting an overall decrease in acute ischemic stroke admissions as well as total number of endovascular treatments will be reviewed. Although the underlying reasons therefore remain the matter of debate, it seems that the imposed restrictions, requiring social distancing, and stopping all nonessential services, have led to a higher threshold for patients to seek medical attention, in particular in those with less severe symptoms. Thus, raising public awareness on the importance of strokes and transient ischemic attacks is even more important in the light of the current situation to avoid serious healthcare, economic consequences, and limit long term morbidity. SUMMARY: The priority remains maintaining a fast and efficient pre and in-hospital work-flow while mitigating nosocomial transmission and protecting the patient and the healthcare workers with appropriate personal protective equipment.


Subject(s)
Brain Ischemia/surgery , COVID-19 , Endovascular Procedures/methods , Thrombectomy/statistics & numerical data , Communicable Disease Control , Endovascular Procedures/statistics & numerical data , Humans , Pandemics
6.
J Neurointerv Surg ; 12(11): 1045-1048, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-807808

ABSTRACT

BACKGROUND: We aimed to compare the outcome of acute ischemic stroke (AIS) patients who received endovascular thrombectomy (EVT) with confirmed COVID-19 to those without. METHODS: We performed a retrospective analysis using the Vizient Clinical Data Base and included hospital discharges from April 1 to July 31 2020 with ICD-10 codes for AIS and EVT. The primary outcome was in-hospital death and the secondary outcome was favorable discharge, defined as discharge home or to acute rehabilitation. We compared patients with laboratory-confirmed COVID-19 to those without. As a sensitivity analysis, we compared COVID-19 AIS patients who did not undergo EVT to those who did, to balance potential adverse events inherent to COVID-19 infection. RESULTS: We identified 3165 AIS patients who received EVT during April to July 2020, in which COVID-19 was confirmed in 104 (3.3%). Comorbid COVID-19 infection was associated with younger age, male sex, diabetes, black race, Hispanic ethnicity, intubation, acute coronary syndrome, acute renal failure, and longer hospital and intensive care unit length of stay. The rate of in-hospital death was 12.4% without COVID-19 vs 29.8% with COVID-19 (P<0.001). In mixed-effects logistic regression that accounted for patient clustering by hospital, comorbid COVID-19 increased the odds of in-hospital death over four-fold (OR 4.48, 95% CI 3.02 to 6.165). Comorbid COVID-19 was also associated with lower odds of a favorable discharge (OR 0.43, 95% CI 0.30 to 0.61). In the sensitivity analysis, comparing AIS patients with COVID-19 who did not undergo EVT (n=2139) to the AIS EVT patients with COVID-19, there was no difference in the rate of in-hospital death (30.6% vs 29.8%, P=0.868), and AIS EVT patients had a higher rate of favorable discharge (32.4% vs 47.1%, P=0.002). CONCLUSION: In AIS patients treated with EVT, comorbid COVID-19 infection was associated with in-hospital death and a lower odds of favorable discharge compared with patients without COVID-19, but not compared with AIS patients with COVID-19 who did not undergo EVT. AIS EVT patients with COVID-19 were younger, more likely to be male, have systemic complications, and almost twice as likely to be black and over three times as likely to be Hispanic.


Subject(s)
Brain Ischemia/complications , Brain Ischemia/surgery , Coronavirus Infections/complications , Endovascular Procedures/statistics & numerical data , Pneumonia, Viral/complications , Stroke/complications , Stroke/surgery , Thrombectomy/statistics & numerical data , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19 , Comorbidity , Endovascular Procedures/methods , Female , Hospital Mortality , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , Sex Factors , Socioeconomic Factors , Stroke Rehabilitation/statistics & numerical data , Thrombectomy/methods , Treatment Outcome , Young Adult
7.
BMC Neurol ; 20(1): 358, 2020 Sep 24.
Article in English | MEDLINE | ID: covidwho-792799

ABSTRACT

BACKGROUND: The novel coronavirus (COVID-19) global pandemic is associated with an increased incidence of acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO). The treatment of these patients poses unique and significant challenges to health care providers requiring changes in existing protocols. CASE PRESENTATION: A 54-year-old COVID-19 positive patient developed sudden onset left hemiparesis secondary to an acute right middle cerebral artery occlusion (National Institutes of Health Stroke Scale (NIHSS) score = 11). Mechanical thrombectomy (MT) was performed under a new protocol specifically designed to maximize protective measures for the team involved in the care of the patient. Mechanical Thrombectomy was performed successfully under general anesthesia resulting in TICI 3 recanalization. With regards to time metrics, time from door to reperfusion was 60 mins. The 24-h NIHSS score decreased to 2. Patient was discharged after 19 days after improvement of her pulmonary status with modified Rankin Scale = 1. CONCLUSION: Patients infected by COVID-19 can develop LVO that is multifactorial in etiology. Mechanical thrombectomy in a COVID-19 confirmed patient presenting with AIS due to LVO is feasible with current mechanical thrombectomy devices. A change in stroke workflow and protocols is now necessary in order to deliver the appropriate life-saving therapy for COVID-19 positive patients while protecting medical providers.


Subject(s)
Coronavirus Infections/complications , Endovascular Procedures/methods , Infarction, Middle Cerebral Artery/surgery , Personal Protective Equipment , Pneumonia, Viral/complications , Thrombectomy/methods , Betacoronavirus , Brain Ischemia/complications , Brain Ischemia/diagnostic imaging , Brain Ischemia/surgery , COVID-19 , Cerebral Angiography , Computed Tomography Angiography , Emergency Medical Services , Female , Humans , Infarction, Middle Cerebral Artery/complications , Infarction, Middle Cerebral Artery/diagnostic imaging , Intubation, Intratracheal , Middle Aged , Pandemics , Reperfusion , SARS-CoV-2 , Stroke/complications , Stroke/diagnostic imaging , Stroke/surgery , Time-to-Treatment , Treatment Outcome
8.
AJNR Am J Neuroradiol ; 41(10): 1849-1855, 2020 10.
Article in English | MEDLINE | ID: covidwho-724309

ABSTRACT

BACKGROUND AND PURPOSE: Chest CT is a rapid, useful additional screening tool for coronavirus disease 2019 (COVID-19) in emergent procedures. We describe the feasibility and interim outcome of implementing a modified imaging algorithm for COVID-19 risk stratification across a regional network of primary stroke centers in the work-up of acute ischemic stroke referrals for time-critical mechanical thrombectomy. MATERIALS AND METHODS: We undertook a retrospective review of 49 patients referred to the regional neuroscience unit for consideration of mechanical thrombectomy between April 14, 2020, and May 21, 2020. During this time, all referring units followed a standard imaging protocol that included a chest CT in addition to a head CT and CT angiogram to identify Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infective pulmonary changes. RESULTS: Overall, 2 patients had typical COVID-19 radiologic features and tested positive, while 7 patients had indeterminate imaging findings and tested negative. The others had normal or atypical changes and were not diagnosed with or suspected of having COVID-19. There was an overall sensitivity of 100%, specificity of 74.1%, negative predictive value of 100%, and positive predictive value of 22.2% when using chest CT to diagnose COVID-19 in comparison with the real-time reverse transcriptase-polymerase chain reaction test. The mean additional time and radiation dose incurred for the chest CT were 184 ± 65.5 seconds and 2.47 ± 1.03 mSv. Multiple cardiovascular and pulmonary incidental findings of clinical relevance were identified in our patient population. CONCLUSIONS: Chest CT provides a pragmatic, rapid additional tool for COVID-19 risk stratification among patients referred for mechanical thrombectomy. Its inclusion in a standardized regional stroke imaging protocol has enabled efficient use of hospital resources with minimal compromise or delay to the overall patient treatment schedule.


Subject(s)
Betacoronavirus , Brain Ischemia/diagnostic imaging , Coronavirus Infections/complications , Pneumonia, Viral/complications , Stroke/diagnostic imaging , Aged , Aged, 80 and over , Brain Ischemia/etiology , Brain Ischemia/surgery , COVID-19 , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Stroke/etiology , Stroke/surgery , Thrombectomy , Tomography, X-Ray Computed
9.
Clin Radiol ; 75(10): 795.e7-795.e13, 2020 10.
Article in English | MEDLINE | ID: covidwho-643322

ABSTRACT

AIM: To describe evolving practices in the provision of mechanical thrombectomy (MT) services across the UK during the COVID-19 pandemic, the responses of and impact on MT teams, and the effects on training. MATERIALS AND METHODS: The UK Neurointerventional Group (UKNG) and the British Society of Neuroradiologists (BSNR) sent out a national survey on 1 May 2020 to all 28 UK neuroscience centres that have the potential capability to perform MT. RESULTS: Responses were received from 27/28 MT-capable centres (96%). Three of the 27 centres do not currently provide MT services. There was a 27.7% reduction in MTs performed during April 2020 compared with the first 3 months of the year. All MT patients in 20/24 centres that responded were considered as COVID-19 suspicious/positive unless or until proven otherwise. Twenty-two of the 24 centres reported delays to the patient pathway. Seventeen of the 24 centres reported that the COVID-19 pandemic had reduced training opportunities for specialist registrars (SpR). Fourteen of the 24 centres reported that the pandemic had hampered their development plans for their local or regional MT service. CONCLUSION: The present survey has highlighted a trend of decreasing cases and delays in the patient pathway during the early stages of the COVID-19 pandemic across UK centres.


Subject(s)
Brain Ischemia/surgery , Coronavirus Infections/prevention & control , Mechanical Thrombolysis/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Stroke/surgery , Brain Ischemia/complications , COVID-19 , Clinical Protocols , Humans , United Kingdom
10.
Stroke ; 51(9): e215-e218, 2020 09.
Article in English | MEDLINE | ID: covidwho-636399

ABSTRACT

BACKGROUND AND PURPOSE: Young patients with malignant cerebral edema have been shown to benefit from early decompressive hemicraniectomy. The impact of concomitant infection with coronavirus disease 2019 (COVID-19) and how this should weigh in on the decision for surgery is unclear. METHODS: We retrospectively reviewed all COVID-19-positive patients admitted to the neuroscience intensive care unit for malignant edema monitoring. Patients with >50% of middle cerebral artery involvement on computed tomography imaging were considered at risk for malignant edema. RESULTS: Seven patients were admitted for monitoring of whom 4 died. Cause of death was related to COVID-19 complications, and these were either seen both very early and several days into the intensive care unit course after the typical window of malignant cerebral swelling. Three cases underwent surgery, and 1 patient died postoperatively from cardiac failure. A good outcome was attained in the other 2 cases. CONCLUSIONS: COVID-19-positive patients with large hemispheric stroke can have a good outcome with decompressive hemicraniectomy. A positive test for COVID-19 should not be used in isolation to exclude patients from a potentially lifesaving procedure.


Subject(s)
Brain Ischemia/complications , Brain Ischemia/surgery , Coronavirus Infections/complications , Decompressive Craniectomy/methods , Neurosurgical Procedures/methods , Pneumonia, Viral/complications , Stroke/complications , Stroke/surgery , Adult , Brain Edema/complications , Brain Edema/surgery , Brain Ischemia/diagnostic imaging , COVID-19 , Cause of Death , Clinical Decision-Making , Critical Care , Decompressive Craniectomy/adverse effects , Female , Humans , Male , Middle Aged , Monitoring, Physiologic , Neurosurgical Procedures/adverse effects , Pandemics , Retrospective Studies , Stroke/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome
11.
J Neurosurg Anesthesiol ; 32(3): 193-201, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-548377

ABSTRACT

The pandemic of coronavirus disease 2019 (COVID-19) has unique implications for the anesthetic management of endovascular therapy for acute ischemic stroke. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert recommendations using available evidence for the safe and effective anesthetic management of endovascular therapy for acute ischemic stroke during the COVID-19 pandemic. The goal of this consensus statement is to provide recommendations for anesthetic management considering the following (and they are): (1) optimal neurological outcomes for patients; (2) minimizing the risk for health care professionals, and (3) facilitating judicious use of resources while accounting for existing variability in care. It provides a framework for selecting the optimal anesthetic technique (general anesthesia or monitored anesthesia care) for a given patient and offers suggestions for best practices for anesthesia care during the pandemic. Institutions and health care providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.


Subject(s)
Anesthesiology/methods , Brain Ischemia/surgery , Coronavirus Infections/prevention & control , Endovascular Procedures/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Stroke/surgery , Betacoronavirus , Brain Ischemia/complications , COVID-19 , Consensus , Critical Care , Europe , Humans , Minimally Invasive Surgical Procedures , Neurosciences , Neurosurgery , SARS-CoV-2 , Societies, Medical , Stroke/complications , United States
12.
J Neurosurg Anesthesiol ; 32(3): 202-209, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-525809

ABSTRACT

The pandemic of coronavirus disease 2019 (COVID-19) has several implications relevant to neuroanesthesiologists, including neurological manifestations of the disease, impact of anesthesia provision for specific neurosurgical procedures and electroconvulsive therapy, and health care provider wellness. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert guidance for neuroanesthesiologists during the COVID-19 pandemic. The aim of this document is to provide a focused overview of COVID-19 disease relevant to neuroanesthesia practice. This consensus statement provides information on the neurological manifestations of COVID-19, advice for neuroanesthesia clinical practice during emergent neurosurgery, interventional radiology (excluding endovascular treatment of acute ischemic stroke), transnasal neurosurgery, awake craniotomy and electroconvulsive therapy, as well as information about health care provider wellness. Institutions and health care providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.


Subject(s)
Anesthesia/methods , Brain Ischemia/surgery , Coronavirus Infections/prevention & control , Neurosurgery/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Stroke/surgery , Betacoronavirus , Brain Ischemia/complications , COVID-19 , Critical Care , Humans , SARS-CoV-2 , Societies, Medical , Stroke/complications
13.
J Neurointerv Surg ; 12(7): 664-668, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-391663

ABSTRACT

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic is still spreading across the world. Although the pandemic has an all-round impact on medical work, the degree of its impact on endovascular thrombectomy (EVT) for patients with acute ischemic stroke (AIS) is unclear. METHODS: We continuously included AIS patients with large artery occlusion who underwent EVT in a comprehensive stroke center before and during the Wuhan shutdown. The protected code stroke (PCS) for screening and treating AIS patients was established during the pandemic. The efficacy and safety outcomes including the rate of successful reperfusion (defined as modified Thrombolysis In Cerebral Infarction (mTICI) graded 2b or 3) and time intervals for reperfusion were compared between two groups: pre-pandemic and pandemic. RESULTS: A total of 55 AIS patients who received EVT were included. The baseline characteristics were comparable between the two groups. The time from hospital arrival to puncture (174 vs 125.5 min; p=0.002) and time from hospital arrival to reperfusion (213 vs 172 min; p=0.047) were significantly prolonged in the pandemic group compared with the pre-pandemic group. The rate of successful reperfusion was not significantly different between the two groups (85.7% (n=18) vs 88.2% (n=30); OR 0.971, 95% CI 0.785 to 1.203; p=1.000). CONCLUSION: The results of this study suggest a proper PCS algorithm which combines the COVID-19 screening and protection measures could decrease the impact of the disease on the clinical outcomes of EVT for AIS patients to the lowest extent possible during the pandemic.


Subject(s)
Betacoronavirus , Brain Ischemia/epidemiology , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Stroke/epidemiology , Thrombectomy/trends , Aged , Aged, 80 and over , Brain Ischemia/surgery , COVID-19 , Coronavirus Infections/surgery , Endovascular Procedures/methods , Endovascular Procedures/trends , Female , Humans , Male , Middle Aged , Pneumonia, Viral/surgery , Reperfusion , Retrospective Studies , SARS-CoV-2 , Stroke/surgery , Thrombectomy/methods , Treatment Outcome
14.
Stroke ; 51(7): 2012-2017, 2020 07.
Article in English | MEDLINE | ID: covidwho-327129

ABSTRACT

BACKGROUND AND PURPOSE: 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). METHODS: 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). RESULTS: 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). CONCLUSIONS: 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.


Subject(s)
Betacoronavirus , Brain Ischemia/surgery , Coronavirus Infections , Delivery of Health Care , Mechanical Thrombolysis/statistics & numerical data , Pandemics , Pneumonia, Viral , Stroke/surgery , Aged , Aged, 80 and over , Brain Ischemia/epidemiology , COVID-19 , Female , France/epidemiology , Hospitalization/statistics & numerical data , Humans , Male , Mechanical Thrombolysis/methods , Middle Aged , Patient Admission/statistics & numerical data , Procedures and Techniques Utilization , Prospective Studies , SARS-CoV-2 , Stroke/epidemiology , Time-to-Treatment/statistics & numerical data
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