Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak
Basile Kerleroux, Thibaut Fabacher, Nicolas Bricout, Martin Moïse, Benoît Testud, Sivadji Vingadassalom, Héloïse Ifergan, Kévin Janot, Arturo Consoli, Wagih Ben Hassen, Eimad Shotar, Julien Ognard, Guillaume Charbonnier, Vincent L’Allinec, Alexis Guédon, Federico Bolognini, Gaultier Marnat, Géraud Forestier, Aymeric Rouchaud, Raoul Pop, Nicolas Raynaud, François Zhu, Jonathan Cortese, Vanessa Chalumeau, Jérôme Berge, Simon Escalard, Grégoire Boulouis, Cyril Chivot, Riyad Hanafi, A. Pasco, Jean-Baptiste Girot, Alessandra Biondi, Fortunato Di Caterino, Panagiotis Primikiris, Giovanni Vitale, Louise Bonnet, Florent Gariel, Xavier Barreau, Sabrina Debruxelles, Ludovic Lucas, Patrice Ménégon, Stéphane Olindo, Mathilde Poli, Pauline Renou, Sharmila Sagnier, Igor Sibon, Louis Veunac, Jean‐Christophe Gentric, Charlotte Barbier, Marion Boulanger, Julien Cogez, Sophie Guettier, Romain Schneckenburger, Emmanuel Touzé, Mariette Delaître, Pablo Lebendinsky, M. Musacchio, F. Ricolfi, Pierre Thouant, François Caparros, Barbara Casolla, Lucie Della Schiava, Nelly Dequatre, Hilde Hénon, Marco Pasi, Apolline Kazémi, Fouzi Bala, Laurent Estrade, Charbel Mounayer, Susanna Saleme, Francisco Macian-Montoro, Omer Eker, François Cotton, Karine Blanc‐Lasserre, Serkan Cakmak, Tae‐Hee Cho, Laurent Derex, Anne‐Claire Lukaszewicz, Laura Mechtouff, Norbert Nighoghossian, Frédéric Philippeau, Roberto Riva, Francis Turjman, Anne‐Evelyne Vallet, Xavier Carle, Philippe Dory‐Lautrec, Anthony Reyre, Jean‐François Hak, Hervé Brunel, Amel Benali, François-Louis Collemiche, Cyril Dargazanli, Frederico Cagnazzo, Imad Derraz, Caroline Arquizan, Lucas Corti, Vincent Costalat, Nicolas Gaillard, Grégory Gascou, Pierre-Henri Lefèvre
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 ( R 2 −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.