Impact of COVID-19 Pandemic on a Regional Stroke Thrombectomy Service in the United Kingdom

Abstract

<b><i>Introduction:</i></b> We examined the impact of the coronavirus disease 2019 (COVID-19) pandemic on our regional stroke thrombectomy service in the UK. <b><i>Methods:</i></b> This was a single-center health service evaluation. We began testing for COVID-19 on 3 March and introduced a modified “COVID Stroke Thrombectomy Pathway” on 18 March. We analyzed the clinical, procedural and outcome data for 61 consecutive stroke thrombectomy patients between 1 January and 30 April. We compared the data for January and February (“pre-COVID,” <i>n</i> = 33) versus March and April (“during COVID,” <i>n</i> = 28). <b><i>Results:</i></b> Patient demographics were similar between the 2 groups (mean age 71 ± 12.8 years, 39% female). During the COVID-19 pandemic, (a) total stroke admissions fell by 17% but the thrombectomy rate was maintained at 20% of ischemic strokes; (b) successful recanalization rate was maintained at 81%; (c) early neurological outcomes (neurological improvement following thrombectomy and inpatient mortality) were not significantly different; (d) use of general anesthesia fell significantly from 85 to 32% as intended; and (e) time intervals from onset to arrival, groin puncture, and recanalization were not significantly different, whereas internal delays for external referrals significantly improved for door-to-groin puncture (48 [interquartile range (IQR) 39–57] vs. 33 [IQR 27–44] minutes, <i>p</i> = 0.013) and door-to-recanalization (82.5 [IQR 61–110] vs. 60 [IQR 55–70] minutes, <i>p</i> = 0.018). <b><i>Conclusion:</i></b> The COVID-19 pandemic has had a negative impact on the stroke admission numbers but not stroke thrombectomy rate, successful recanalization rate, or early neurological outcome. Internal delays actually improved during the COVID-19 pandemic. Further studies should examine the effects of the COVID-19 pandemic on longer term outcome.

Change in stroke presentations during COVID-19 pandemic in South-Western Sydney

“…The initial decrease in stroke presentations was followed by a rebound of 77% in the period May-June. The initial decrease in cases was like that reported in the literature (15,17–22,24–28,34–39). We saw a reduction in stroke presentations despite a relatively low incidence of SARS-CoV-2 infections compared to other centres internationally.…”

Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis

“…Most studies compared the pandemic period (ranging from January to June 2020) to a similar period in the preceding year (range January to June 2019) [28][29][30][31]33,35,39,[41][42][43]45,46,[48][49][50]52,[54][55][56][57][58]60 or the months preceding the pandemic (range September 2019 to December 2019). 8,32,34,[36][37][38]40,44,47,51,53,59,[61][62][63]…”

Differential Influence of the COVID-19 Pandemic on Mechanical Thrombectomy and Bridging Therapy for Acute Ischemic Stroke

“…In addition, the stroke nursing center implements the strict screening of MT for eligible patients. Finally, the number of patients who meet the strict guidelines of MT decreases ( 4 , 5 ). Other possible reasons are the increase in healthy lifestyle due to the COVID-19 epidemic restriction policy, which keeps people away from hospital ( 17 , 18 ), or residents in areas around Wenzhou, where the restrictions are in place, may opt for less busy local medical facilities nearby, are not stroke treatment facilities.…”

“…A study reported a decrease of 21% in MT cases in the COVID-19 pandemic in France ( 4 ). Other research has shown a 21% decrease in MT interventions performed by the outpatient referral hospital in the United Kingdom ( 5 ). In some research, COVID-19 has not affected the short-term outcomes of patients with MT.…”