Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak in France: Decreased Activity, and Increased Care Delays

Kerleroux, Basile; Fabacher, Thibaut; Bricout, Nicolas; Moïse, Martin; Testud, Benoît; Vingadassalom, Sivadji; Ifergan, Héloïse; Janot, Kévin; Consolli, Arturo; Hassen, Wagih Ben; Shotar, Eimad; Charbonnier, Guillaume; Guédon, Alexis; Bolognini, Federico; Marnat, Gaultier; Forestier, Géraud; Rouchaud, Aymeric; Pop, Raoul; Zhu, François; Cortese, Jonathan; Chalumeau, Vanessa; Escalard, Simon; Berge, Jérôme; Boulouis, Grégoire

doi:10.2139/ssrn.3571545

Cited by 70 publications

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“…[1][2][3] These changes to clinical operations were aimed at creating capacity and preserving resources so that hospitals could deal with a projected surge in COVID-19 patients while continuing to care for patients with other acute medical conditions necessitating treatment. However, there is emerging evidence from media 4 and the scientific literature [5][6][7][8] that the volume of patients receiving care for emergent and time-sensitive conditions has also decreased.…”

Section: Introductionmentioning

confidence: 99%

“…7 France, another nation that has been hit hard by the pandemic, also experienced a significant decrease in the number of ECRs performed. 8 The decline in patients receiving care for AIS in these European settings was postulated to be due to saturation of emergency medical services, including emergency transport system capacity, during the crisis. 7,8 In comparison with the United States, France and Catalonia, which were the focus of previous analyses of the collateral effects of the pandemic on stroke imaging and care, Australia has had a low prevalence of COVID-19.…”

Section: Introductionmentioning

confidence: 99%

“…8 The decline in patients receiving care for AIS in these European settings was postulated to be due to saturation of emergency medical services, including emergency transport system capacity, during the crisis. 7,8 In comparison with the United States, France and Catalonia, which were the focus of previous analyses of the collateral effects of the pandemic on stroke imaging and care, Australia has had a low prevalence of COVID-19. 7,8,15 Our emergency transport services and hospitals have not been overwhelmed.…”

Section: Introductionmentioning

confidence: 99%

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Where have our patients gone? The impact of COVID‐19 on stroke imaging and intervention at an Australian stroke center

2020

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Introduction: Australia has fortunately had a low prevalence coronavirus disease 2019 (COVID-19), and our healthcare system has not been overwhelmed. We aimed to determine whether, despite this, a decline in acute stroke presentations, imaging and intervention occurred during the pandemic at a busy stroke centre. Methods: The number of 'code stroke' activations, multimodal CTs and endovascular clot retrievals (ECRs) performed during the pandemic period (3/1/2020-5/10/2020) at a large comprehensive stroke centre was compared against the pre-pandemic period (3/1/2019-1/31/2019) using Z-statistics. Year-on-year comparison of the number of patients with large vessel occlusions (LVOs) and ECRs performed per month was also made. Results: The number of 'code stroke' activations and patients undergoing multimodal CT per month decreased significantly (P < 0.0025) following lockdown on 29th March. The number of ECRs also decreased (P = 0.165). The nadir in the weekly number of CTs coincided with lockdown and the peak of new COVID-19 cases. The number of patients with LVOs and ECRs increased by 15% and 14%, respectively, in March but decreased by 55% and 48%, respectively, in April. Conclusions: The significant decrease in volume of 'code stroke' activations and acute stroke imaging following lockdown was accompanied by a concomitant decrease in patients with LVOs and ECRs. The decrease in imaging was therefore not driven purely by patients with mild strokes and stroke mimics, but also included those with severe strokes. Since Australia had a low prevalence of COVID-19, this observed decrease cannot be attributed to hospital congestion and is instead likely driven by patient fear.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Where have our patients gone? The impact of COVID‐19 on stroke imaging and intervention at an Australian stroke center

2020

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“…Prothrombotic state leading to arterial and venous thrombosis is a known complication of this disease with stroke being the most reported neurological presentation [4,6]. Additionally, SARS-CoV-2 pandemic has led to a signi cant decrease in the number of stroke cases presenting to the hospitals, prolonged time from symptoms to hospital arrival and reperfusion [7,8,13]. Furthermore, protocols have been suggested to ensure the safety of stroke team personnel during the pandemic but there is no change in the criteria for mechanical thrombectomy [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…Attention has been drawn lately to the thromboembolic sequalae of this disease, including ischemic strokes, due to the drastic outcome of these complication [4][5][6]. Though there is apparent signi cant reduction in stroke cases presenting to the hospitals during the pandemic [7,8], it was shown that COVID-19 has a high incidence of acute cerebrovascular disease [9] .…”

Section: Introductionmentioning

confidence: 99%

Mechanical Thrombectomy of Large Vessel Occlusions in COVID-19 Related Stroke: Endovascular and Clinical Outcomes

Al-Smadi

Abrol

Luqman

et al. 2020

Preprint

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Background and PurposeStroke is a drastic complication and a poor prognostic marker of COVID-19 disease which emphasizes the importance of early identification and management of this complication. In this case series, we describe our experience of mechanical thrombectomy of large vessel occlusions (LVO) in patients with COVID-19.MethodsWe performed a retrospective study of a series of confirmed COVID-19 patients who underwent endovascular thrombectomy for acute cerebrovascular ischemic disease with large vessel occlusion. Patient demographics, presentations, lab values, angiographic and clinical outcomes were also reviewed.ResultsThree COVID-19 patients with large vessel occlusion who underwent endovascular thrombectomy were identified in our multi-center institution. Two patients had respiratory symptoms prior presentation and one patient presented initially with clinical deficits. Two patients had anterior circulation occlusion in the middle cerebral artery territory vs one had posterior circulation occlusion in the basilar artery. There was good angiographic outcome post thrombectomy in all patients, however poor clinical outcomes noted with no significant improvement in neurological manifestations in comparison with baseline at presentation. All patients developed critically severe symptoms during hospitalization requiring intubation and one patient died of COVID-19 related respiratory failure.ConclusionIn this small case series, we noted worse clinical outcomes in COVID-19 related LVO stroke despite effective thrombectomy, which may be related to the underlying COVID-19 disease and/or the nature of clot in these patients.

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A meta‐analysis of the global impact of the COVID‐19 pandemic on stroke care & the Houston Experience

Reddy

Satani

Beauchamp

et al. 2021

Ann Clin Transl Neurol

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Objective To review the global impact of the COVID‐19 pandemic on stroke care‐metrics and report data from a health system in Houston. Methods We performed a meta‐analysis of the published literature reporting stroke admissions, intracerebral hemorrhage (ICH) cases, number of thrombolysis (tPA) and thrombectomy (MT) cases, and time metrics (door to needle, DTN; and door to groin time, DTG) during the pandemic compared to prepandemic period. Within our hospital system, between January–June 2019 and January–June 2020, we compared the proportion of stroke admissions and door to tPA and MT times. Results A total of 32,640 stroke admissions from 29 studies were assessed. Compared to prepandemic period, the mean ratio of stroke admissions during the pandemic was 70.78% [95% CI, 65.02%, 76.54%], ICH cases was 83.10% [95% CI, 71.01%, 95.17%], tPA cases was 81.74% [95% CI, 72.33%, 91.16%], and MT cases was 88.63% [95% CI, 74.12%, 103.13%], whereas DTN time was 104.48% [95% CI, 95.52%, 113.44%] and DTG was 104.30% [95% CI, 81.99%, 126.61%]. In Houston, a total of 4808 cases were assessed. There was an initial drop of ~30% in cases at the pandemic onset. Compared to 2019, there was a significant reduction in mild strokes (NIHSS 1‐5) [N (%), 891 (43) vs 635 (40), P = 0.02]. There were similar mean (SD) (mins) DTN [44 (17) vs 42 (17), P = 0.14] but significantly prolonged DTG times [94 (15) vs 85 (20), P = 0.005] in 2020. Interpretation The COVID‐19 pandemic led to a global reduction in stroke admissions and treatment interventions and prolonged treatment time metrics.

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Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak in France: Decreased Activity, and Increased Care Delays

Cited by 70 publications

References 0 publications

Where have our patients gone? The impact of COVID‐19 on stroke imaging and intervention at an Australian stroke center

Where have our patients gone? The impact of COVID‐19 on stroke imaging and intervention at an Australian stroke center

Mechanical Thrombectomy of Large Vessel Occlusions in COVID-19 Related Stroke: Endovascular and Clinical Outcomes

A meta‐analysis of the global impact of the COVID‐19 pandemic on stroke care & the Houston Experience

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