Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak: Decreased Activity, and Increased Care Delays
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). We conducted a prospective national-...
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| Veröffentlicht in: | Stroke (1970) Jg. 51; H. 7; S. 2012 |
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| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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United States
01.07.2020
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| ISSN: | 1524-4628, 1524-4628 |
| Online-Zugang: | Weitere Angaben |
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| Abstract | 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).
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).
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];
<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;
<0.001 in 2019) and in transferred patients (mean 182.6±SD 82.0 minutes versus 153.25±67;
<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 (
-0.51;
=0.04). Patients treated during the COVID outbreak were less likely to receive intravenous thrombolysis and to have unwitnessed strokes (both
<0.05).
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. |
|---|---|
| AbstractList | 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).
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).
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];
<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;
<0.001 in 2019) and in transferred patients (mean 182.6±SD 82.0 minutes versus 153.25±67;
<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 (
-0.51;
=0.04). Patients treated during the COVID outbreak were less likely to receive intravenous thrombolysis and to have unwitnessed strokes (both
<0.05).
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. 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).BACKGROUND AND PURPOSEThe 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).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).METHODSWe 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).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).RESULTSA 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).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.CONCLUSIONSOur 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. |
| Author | Zhu, François Escalard, Simon Forestier, Géraud Ifergan, Héloïse Testud, Benoit Moïse, Martin Raynaud, Nicolas Pop, Raoul Bricout, Nicolas Vingadassalom, Sivadji Guédon, Alexis Ognard, Julien Chalumeau, Vanessa Shotar, Eimad Kerleroux, Basile Charbonnier, Guillaume Rouchaud, Aymeric Cortese, Jonathan Bolognini, Federico Janot, Kévin Ben Hassen, Wagih Fabacher, Thibaut Consoli, Arturo Berge, Jérome Marnat, Gaultier Boulouis, Grégoire L'Allinec, Vincent |
| Author_xml | – sequence: 1 givenname: Basile surname: Kerleroux fullname: Kerleroux, Basile organization: Neuroradiology Department, CH Sainte-Anne, Paris, France (B.K., W.B.H., G.B.) – sequence: 2 givenname: Thibaut surname: Fabacher fullname: Fabacher, Thibaut organization: Public Health, CHRU Strasbourg, France (T.F.) – sequence: 3 givenname: Nicolas surname: Bricout fullname: Bricout, Nicolas organization: Interventional Neuroradiology Department, CHRU Lille, France (N.B., M.M.) – sequence: 4 givenname: Martin surname: Moïse fullname: Moïse, Martin organization: Interventional Neuroradiology Department, CHRU Lille, France (N.B., M.M.) – sequence: 5 givenname: Benoit surname: Testud fullname: Testud, Benoit organization: Interventional Neuroradiology Department, CHRU Marseille La Timone, France (B.T., S.V.) – sequence: 6 givenname: Sivadji surname: Vingadassalom fullname: Vingadassalom, Sivadji organization: Interventional Neuroradiology Department, CHRU Marseille La Timone, France (B.T., S.V.) – sequence: 7 givenname: Héloïse surname: Ifergan fullname: Ifergan, Héloïse organization: Interventional Neuroradiology Department, CHRU Tours, France (H.I., K.J.) – sequence: 8 givenname: Kévin surname: Janot fullname: Janot, Kévin organization: Interventional Neuroradiology Department, CHRU Tours, France (H.I., K.J.) – sequence: 9 givenname: Arturo surname: Consoli fullname: Consoli, Arturo organization: Interventional Neuroradiology Department, CH Foch, France (A.C.) – sequence: 10 givenname: Wagih surname: Ben Hassen fullname: Ben Hassen, Wagih organization: Neuroradiology Department, CH Sainte-Anne, Paris, France (B.K., W.B.H., G.B.) – sequence: 11 givenname: Eimad surname: Shotar fullname: Shotar, Eimad organization: Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France (E.S.) – sequence: 12 givenname: Julien surname: Ognard fullname: Ognard, Julien organization: Interventional Neuroradiology Department, CHRU Brest, France (J.O.) – sequence: 13 givenname: Guillaume surname: Charbonnier fullname: Charbonnier, Guillaume organization: Interventional Neuroradiology Department, CHRU Besançon, France (G.C.) – sequence: 14 givenname: Vincent surname: L'Allinec fullname: L'Allinec, Vincent organization: Radiology Department, CHU Angers, France (V.L.) – sequence: 15 givenname: Alexis surname: Guédon fullname: Guédon, Alexis organization: Department of Neuroradiology, Lariboisière Hospital, Paris, France (A.G.) – sequence: 16 givenname: Federico surname: Bolognini fullname: Bolognini, Federico organization: Interventional Neuroradiology Department, CHRU Colmar, France (F.B.) – sequence: 17 givenname: Gaultier surname: Marnat fullname: Marnat, Gaultier organization: Interventional Neuroradiology Department, CHRU Bordeaux, France (G.M., J.B.) – sequence: 18 givenname: Géraud surname: Forestier fullname: Forestier, Géraud organization: Interventional Neuroradiology Department, CHU Limoges, France (G.F., A.R.) – sequence: 19 givenname: Aymeric surname: Rouchaud fullname: Rouchaud, Aymeric organization: Interventional Neuroradiology Department, CHU Limoges, France (G.F., A.R.) – sequence: 20 givenname: Raoul surname: Pop fullname: Pop, Raoul organization: Interventional Neuroradiology Department, CHRU Strasbourg, France (R.P.) – sequence: 21 givenname: Nicolas surname: Raynaud fullname: Raynaud, Nicolas organization: Interventional Neuroradiology Department, CHRU Poitiers, France (N.R.) – sequence: 22 givenname: François surname: Zhu fullname: Zhu, François organization: Interventional Neuroradiology Department, CHRU Nancy, France (F.Z.) – sequence: 23 givenname: Jonathan surname: Cortese fullname: Cortese, Jonathan organization: Interventional Neuroradiology Department, Kremlin Bicêtre Hospital, Bicêtre, France (J.C., V.C.) – sequence: 24 givenname: Vanessa surname: Chalumeau fullname: Chalumeau, Vanessa organization: Interventional Neuroradiology Department, Kremlin Bicêtre Hospital, Bicêtre, France (J.C., V.C.) – sequence: 25 givenname: Jérome surname: Berge fullname: Berge, Jérome organization: Interventional Neuroradiology Department, CHRU Bordeaux, France (G.M., J.B.) – sequence: 26 givenname: Simon surname: Escalard fullname: Escalard, Simon organization: Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (S.E.) – sequence: 27 givenname: Grégoire surname: Boulouis fullname: Boulouis, Grégoire organization: Neuroradiology Department, CH Sainte-Anne, Paris, France (B.K., W.B.H., G.B.) |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32432994$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Contributor | Cho, Tae-Hee Della Schiava, Lucie Blanc-Lasserre, Karine Dory-Lautrec, Philippe Liao, Liang Veunac, Louis Lapergue, Bertrand Henon, Hilde Nighoghossian, Norbert Lucas, Ludovic Derex, Laurent Barreau, Xavier Di Caterino, Fortunato Gascou, Grégory Cakmak, Serkan Macian-Montoro, Francisco Gariel, Florent Coskun, Oghuzan Kazemi, Apolline Hanafi, Riyad Mourand, Isabelle Riou-Comte, Nolwenn Gaillard, Nicolas Braun, Marc Mechtouff, Laura Vallet, Anne-Evelyne Cagnazzo, Frederico Girot, Jean-Baptiste Sibon, Igor Saleme, Susanna Bala, Fouzi Tonnelet, Romain Reyre, Anthony Primikiris, Panagiotis Derraz, Imad Lacour, Jean-Christophe Alexandre, Pierre-Louis Guettier, Sophie Carle, Xavier Costalat, Vincent Delaitre, Mariette Di Maria, Frederico Cotton, François Biondi, Alessandra Dequatre, Nelly Bourcier, Romain Touze, Emmanuel Gory, Benjamin Boulanger, Marion Poli, Mathilde Casolla, Barbara Menegon, Patrice Lefèvre, Pierre-Henri Corti, Lucas Eker, Omer Benali, Amel Derelle, Anne Laure Lebendinsky, Pablo Detraz, Lili Richard, Sébastien Debruxelles, Sabrina Th |
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| SubjectTerms | Aged Aged, 80 and over Betacoronavirus Brain Ischemia - epidemiology Brain Ischemia - surgery Coronavirus Infections COVID-19 Delivery of Health Care Female France - epidemiology Hospitalization - statistics & numerical data Humans Male Mechanical Thrombolysis - methods Mechanical Thrombolysis - statistics & numerical data Middle Aged Pandemics Patient Admission - statistics & numerical data Pneumonia, Viral Procedures and Techniques Utilization Prospective Studies SARS-CoV-2 Stroke - epidemiology Stroke - surgery Time-to-Treatment - statistics & numerical data |
| Title | Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak: Decreased Activity, and Increased Care Delays |
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