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

Abstract

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 intrahospital 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.

Decline and Recurrence of Stroke Consultations during the COVID-19 Pandemic Lockdown Parallels Population Activity Levels

“…Diegoli et al [ 16 ] analyzing a population-based stroke registry in Joinville, Brazil, found 36.4% reduction in stroke admissions upon initiation of lockdown measures in 2020 compared to the equivalent time in 2019 with no difference in admissions for severe stroke defined as NIHSS >8, ICB, and SAH. These findings may also be local phenomenon as shown by a publication of the Lyon Stroke Center network and the combined descriptive data of 4 German university stroke units by Hoyer et al [ 2 , 38 ]. The latter group showed a significant decrease in the number of admissions for TIA in 3 of 4 centers upon the lockdown by 85% and a reduction of stroke admission to 46% in 2 of 4 centers.…”

Impact of the COVID-19 Pandemic on Acute Stroke Care, Time Metrics, Outcomes, and Racial Disparities in a Southeast Michigan Health System

“…First, consistent with prior reports, 14 we found that the rates of STA in our EDs dramatically decreased during the pandemic by 54%. Reports around the world vary in the magnitude of this effect based on geographical location and timing of reporting: 9–40% in France, 9 , 15 23–28% in Spain, 4 24–31% in Scandinavia, 16 25% in California, 17 32% in neighboring Ontario (Canada), 18 40% in China, 5 , 14 and 30–46% in New York. 19 These observations are a direct consequence of the implementation of stay-at-home orders and lockdowns enforced by local and federal governments.…”

Initial Management of Patients with Suspected Stroke in the SARS-CoV-2 Era: Effects on the Door-to-Picture Time

“…No significant difference was observed in the onset-to-door time between the two groups (p = 0.97), whereas an almost significant difference was observed in the door-to-picture time (p = 0.08). The median door-to-picture time did not differ significantly between patients who were diagnosed using CT (15 [10][11][12][13][14][15][16][17][18][19][20][21] vs. 14 [9][10][11][12][13][14][15][16][17][18][19][20][21] min, p = 0.24) (Fig. 3A).…”