Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network
Cécile Plumereau1,2, Tae-Hee Cho2,3, Marielle Buisson4
1Emergency Department, Hospices Civils de Lyon, Lyon, France.
Insights
The COVID-19 pandemic reduced intravenous thrombolysis for acute ischemic stroke but kept mechanical thrombectomy volumes stable. Delays increased for transferred patients, highlighting network-dependent impacts on stroke care.
Area of Science:
- Neurology
- Public Health
- Emergency Medicine
Background:
- The COVID-19 pandemic significantly disrupted healthcare systems globally.
- Acute stroke care pathways were particularly vulnerable to pandemic-related changes.
- Impact on stroke care varies based on local healthcare network structures.
Purpose of the Study:
- To evaluate the effect of the COVID-19 pandemic on acute stroke care.
- To compare reperfusion therapy volumes and treatment delays during the pandemic versus a control period.
- To assess the influence of local stroke network conditions on pandemic impacts.
Main Methods:
- Prospective data collection of acute ischemic stroke (AIS) patients.
- Comparison of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) volumes and delays.
- Analysis of data from COVID-19 period (29/02/2020–10/05/2020) versus control period (29/02/2019–10/05/2019).
Main Results:
- A significant decrease in IVT volume during the COVID-19 period (54.5% vs 69.2%).
- Stable mechanical thrombectomy (MT) volumes observed, but with increased door-to-groin puncture time for transferred patients.
- A considerable increase in daily Emergency Medical Dispatch calls during the pandemic.
Conclusions:
- The COVID-19 pandemic led to reduced IVT use and stable MT use, with increased intra-hospital delays for transferred patients.
- Findings suggest that the pandemic's impact on acute stroke care is contingent upon local stroke network organization.
- Results contrast with national trends, emphasizing the importance of localized network resilience.
Background:
The 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.
Methods:
We 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.
Results:
A 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]. 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).
Conclusions:
Our study showed a decrease in 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.
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