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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Acute Stroke Management During the COVID-19 Pandemic: Does Confinement Impact Eligibility for Endovascular Therapy?

Steven D Hajdu1, Valerie Pittet2, Francesco Puccinelli1

  • 1Department of Interventional and Diagnostic Radiology, Lausanne University Hospital, Switzerland (S.D.H., F.P., B.B., G.S.).

Stroke
|July 28, 2020
PubMed

Insights

The COVID-19 pandemic confinement significantly reduced endovascular therapy (EVT) for acute ischemic stroke by 32%. This led to a 54-minute increase in treatment times, impacting patient care during the pandemic.

Area of Science:

  • Neurology
  • Interventional Cardiology
  • Public Health

Background:

  • The COVID-19 pandemic prompted global health organizations to recommend containment measures, including social distancing and lockdowns.
  • Anecdotal evidence suggested a decline in endovascular therapy (EVT) for acute ischemic stroke with large vessel occlusion during these restrictive periods.

Purpose of the Study:

  • To quantitatively assess the impact of COVID-19 confinement measures on the utilization of EVT for acute ischemic stroke.
  • To evaluate changes in treatment times, specifically onset-to-groin puncture, during the COVID-19 confinement period.

Main Methods:

  • A retrospective, observational study involving 1600 patients across 17 stroke centers in countries with COVID-19 confinement measures.
  • Data collected from November 1, 2019, to April 15, 2020, comparing periods before and after confinement implementation (March 2020).
  • Analysis included the mean number of EVTs per hospital per 2-week interval and mean stroke onset-to-groin puncture time, using the Wilcoxon rank-sum test for comparison.

Main Results:

  • A statistically significant decrease in the mean number of EVTs performed per hospital per 2-week interval was observed post-confinement (6.1) compared to pre-confinement (9.0) (P<0.001).
  • There was a significant increase in the mean stroke onset-to-groin puncture time, rising from 300.3 minutes before confinement to 354.5 minutes after (P<0.001).
  • Preliminary analysis indicated a 32% reduction in EVT procedures and an approximate 54-minute delay in treatment initiation.

Conclusions:

  • COVID-19 confinement measures were associated with a substantial reduction in EVT for acute ischemic stroke.
  • Treatment delays, measured by onset-to-groin puncture time, significantly increased during the confinement period.
  • These findings highlight potential challenges in accessing time-sensitive stroke interventions during public health crises.

Keywords:
COVID-19goalgroinpandemicstandard of care

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