Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network

Abstract

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period.MethodsWe conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods.ResultsA total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period (55 (54.5%) vs 74 (69.2%); p=0.03) and was mainly due to time delay among patients treated with MT. The volume of MT remains stable over the two periods (72 (71.3%) vs 65 (60.8%); p=0.14) but the door-to-groin puncture time increased in patients transferred for MT (237 [187-339] vs 210 [163-260]; p<0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133-2238] vs 1023 [960-1410]; p<0.01).ConclusionsOur study showed a decrease of the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.

Impact of the COVID‐19 pandemic and a national lockdown on hospitalizations for stroke and related 30‐day mortality in France: A nationwide observational study

“…As data on IVT were not available exhaustively, they were not analysed in our study. This should be addressed in future studies to explore the lower rates of IVT reported in local stroke centres in France [31] and abroad [6,28], and the delay in administering endovascular treatments [4,6,28,33].…”

“…As mentioned above, this could be attributable to the higher severity of stroke patients hospitalized during the lockdown, mainly characterized by large vessel occlusion. Of note, in another French study based in a single centre in Lyon, rates of MT remained unchanged during the COVID‐19 outbreak [31], whereas lower rates of all revascularization treatments were observed in Alsace, one of the centres of the epidemic in France [32]. Local experiences might differ from national observations, as the different French territories were not equally affected by the COVID‐19 spread.…”