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Endovascular thrombectomy time metrics in the era of COVID-19: observations from the Society of Vascular and Interventional Neurology Multicenter Collaboration.
Czap, Alexandra L; Zha, Alicia M; Sebaugh, Jacob; Hassan, Ameer E; Shulman, Julie G; Abdalkader, Mohamad; Nguyen, Thanh N; Linfante, Italo; Starosciak, Amy Kathryn; Ortega-Gutierrez, Santiago; Farooqui, Mudassir; Quispe-Orozco, Darko; Vora, Nirav A; Rai, Vivek; Nogueira, Raul G; Haussen, Diogo C; Jillella, Dinesh V; Rana, Ameena; Yu, Siyuan; Thon, Jesse M; Zaidat, Osama O; Khandelwal, Priyank; Bach, Ivo; Sheth, Sunil A; Jadhav, Ashutosh P; Desai, Shashvat M; Jovin, Tudor G; Liebeskind, David S; Siegler, James E.
  • Czap AL; Neurology, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.
  • Zha AM; Neurology, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.
  • Sebaugh J; Neurology, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.
  • Hassan AE; Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA.
  • Shulman JG; Clinical Neuroscience Research, Valley Baptist Medical Center, Harlingen, Texas, USA.
  • Abdalkader M; Neurology, Boston Medical Center, Boston, Massachusetts, USA.
  • Nguyen TN; Neurology, Boston Medical Center, Boston, Massachusetts, USA.
  • Linfante I; Neurology, Boston Medical Center, Boston, Massachusetts, USA.
  • Starosciak AK; Radiology, Boston Medical Center, Boston, Massachusetts, USA.
  • Ortega-Gutierrez S; Interventional Neuroradiology and Endovascular Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA.
  • Farooqui M; Department of Interventional Neuroradiology and Endovascular Neurosurgery, Baptist Health South Florida, Coral Gables, Florida, USA.
  • Quispe-Orozco D; Center for Outcomes Research, Baptist Health South Florida, Coral Gables, Florida, USA.
  • Vora NA; Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Rai V; Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Nogueira RG; Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Haussen DC; Neuroscience Center, Riverside Methodist Hospital, Columbus, Ohio, USA.
  • Jillella DV; Neuroscience Center, Riverside Methodist Hospital, Columbus, Ohio, USA.
  • Rana A; Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Yu S; Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Thon JM; Neurology, Emory University, Atlanta, Georgia, USA.
  • Zaidat OO; Cooper Medical School of Rowan University, Camden, New Jersey, USA.
  • Khandelwal P; Cooper Medical School of Rowan University, Camden, New Jersey, USA.
  • Bach I; Cooper Neurological Institute, Cooper University Health Care, Camden, New Jersey, USA.
  • Sheth SA; Neuroscience Institute, Bons Secours Mercy Health St. Vincent Hospital, Toledo, Ohio, USA.
  • Jadhav AP; Neurology, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
  • Desai SM; Neurology, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
  • Jovin TG; Neurology, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.
  • Liebeskind DS; Neurology, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania, USA.
  • Siegler JE; Neurology, University of Pittsburgh Medical Center Presbyterian Medical Center, Pittsburgh, Pennsylvania, USA.
J Neurointerv Surg ; 2021 Feb 08.
Article in English | MEDLINE | ID: covidwho-1072792
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ABSTRACT

BACKGROUND:

Unprecedented workflow shifts during the coronavirus disease 2019 (COVID-19) pandemic have contributed to delays in acute care delivery, but whether it adversely affected endovascular thrombectomy metrics in acute large vessel occlusion (LVO) is unknown.

METHODS:

We performed a retrospective review of observational data from 14 comprehensive stroke centers in nine US states with acute LVO. EVT metrics were compared between March to July 2019 against March to July 2020 (primary analysis), and between state-specific pre-peak and peak COVID-19 months (secondary analysis), with multivariable adjustment.

RESULTS:

Of the 1364 patients included in the primary analysis (51% female, median NIHSS 14 [IQR 7-21], and 74% of whom underwent EVT), there was no difference in the primary outcome of door-to-puncture (DTP) time between the 2019 control period and the COVID-19 period (median 71 vs 67 min, P=0.10). After adjustment for variables associated with faster DTP, and clustering by site, there remained a trend toward shorter DTP during the pandemic (ßadj=-73.2, 95% CI -153.8-7.4, Pp=0.07). There was no difference in DTP times according to local COVID-19 peaks vs pre-peak months in unadjusted or adjusted multivariable regression (ßadj=-3.85, 95% CI -36.9-29.2, P=0.80). In this final multivariable model (secondary analysis), faster DTP times were significantly associated with transfer from an outside institution (ßadj=-46.44, 95% CI -62.8 to - -30.0, P<0.01) and higher NIHSS (ßadj=-2.15, 95% CI -4.2to - -0.1, P=0.05).

CONCLUSIONS:

In this multi-center study, there was no delay in EVT among patients treated for intracranial occlusion during the COVID-19 era compared with the pre-COVID era.
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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Type of study: Prognostic study Language: English Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Type of study: Prognostic study Language: English Year: 2021
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