Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak
Authors: Kerleroux Basile , Fabacher Thibaut , Bricout Nicolas , Moïse Martin , Testud Benoit , Vingadassalom Sivadji , Ifergan Héloïse , Janot Kévin , Consoli Arturo , Ben Hassen Wagih , Shotar Eimad , Ognard Julien , Charbonnier Guillaume , L’Allinec Vincent , Guédon Alexis , Bolognini Federico , Marnat Gaultier , Forestier Géraud , Rouchaud Aymeric , Pop Raoul , Raynaud Nicolas , Zhu François , Cortese Jonathan , Chalumeau Vanessa , Berge Jérome , Escalard Simon , Boulouis Grégoire , Chivot Cyril , Hanafi Riyad , Pasco Anne , Girot Jean-Baptiste , Biondi Alessandra , Di Caterino Fortunato , Primikiris Panagiotis , Vitale Giovanni , Bonnet Louise , Gariel Florent , Barreau Xavier , Debruxelles Sabrina , Lucas Ludovic , Menegon Patrice , Olindo Stéphane , Poli Mathilde , Renou Pauline , Sagnier Sharmila , Sibon Igor , Veunac Louis , Gentric Jean-Christophe , Barbier Charlotte , Boulanger Marion , Cogez Julien , Guettier Sophie , Schneckenburger Romain , Touze Emmanuel , Delaitre Mariette , Lebendinsky Pablo , Musacchio Mariano , Ricolfi Frédéric , Thouant Pierre , Caparros François , Casolla Barbara , Della Schiava Lucie , Dequatre Nelly , Henon Hilde , Pasi Marco , Kazemi Apolline , Bala Fouzi , Estrade Laurent , Mounayer Charbel , Saleme Susanna , Macian-Montoro Francisco , Eker Omer , Cotton François , Blanc-Lasserre Karine , Cakmak Serkan , Cho Tae-Hee , Derex Laurent , Lukaszewicz Anne-Claire , Mechtouff Laura , Nighoghossian Norbert , Philippeau Frédéric , Riva Roberto , Turjman Francis , Vallet Anne-Evelyne , Carle Xavier , Dory-Lautrec Philippe , Reyre Anthony , Hak Jean-François , Brunel Hervé , Benali Amel , Collemiche François-Louis , Dargazanli Cyril , Cagnazzo Frederico , Derraz Imad , Arquizan Caroline , Corti Lucas , Costalat Vincent , Gaillard Nicolas , Gascou Grégory , Lefèvre Pierre-Henri , Mourand Isabelle , Riquelme Carlos , Derelle Anne Laure , Gory Benjamin , Liao Liang , Tonnelet Romain , Anxionnat René , Bonnerot Mathieu , Bracard Serge , Braun Marc , Humbertjean Lisa , Lacour Jean-Christophe , Mione Gioia , Planel Sophie , Richard Sébastien , Riou-Comte Nolwenn , Schmitt Emmanuelle , Bourcier Romain , Detraz Lili , Desal Hubert , Alexandre Pierre-Louis , Daumas-Duport Benjamin , Lenoble Cédric , Roy Monica , Coskun Oghuzan , Di Maria Frederico , Lapergue Bertrand , Rodesch Georges , Wang Adrien , Weisenburger-Lile David , Zimatore Sergio , Ajili Nadia , Buard Géraldine , Evrard Serge , Gorza Lucas , Gratieux Julie , Leguen Morgan , Marinier Sylvie , Pico Fernando , Poll Roxanna , Rakotoharinandrasana Haja , Tassan Philippe , Tchikviladze Maya , Delvoye François , Hebert Solène , Blanc Raphaël , Ciccio Gabriele , Desilles Jean-Philippe , Maier Benjamin , Mazighi Mikael , Piotin Michel , Redjem Hocine , Smajda Stanislas , Ben Maacha Malek , Corabianu Ovide , De Broucker Thomas , Ille Olivier , Manchon Eric , Obadia Michael , Obadia Mickael , Raynouard Igor , Peres Roxanne , Sabben Candice , Smadja Didier , Taylor Guillaume , Thion Laurie-Anne , Lecler Augustin , Spelle Laurent , Denier Christian , Caroff Jildaz , Chassin Olivier , Spelle laurent , Venditti Laura , Aymard Armand , Betty Jean , Civelli Vittorio , Eliezer Michael , Fantoni Matteo , Houdart Emmanuel , Labeyrie Marc-Antoine , Saint Maurice Jean-Pierre , Kalsoum Erwah , Pacini Aurelien , Ramadane Chawkat , Tuilier Titien , Villain Adrien , Clarencon Frédéric , Degos Vincent , Elhfnawy Ahmed , Elhorany Mahmoud , Lenck Stéphanie , Premat Kevin , Sourour Nader-Antoine , Alamowitch Sonia , Baronnet Flore , Crozier Sophie , Deltour Sandrine , Leger Anne , Rosso Charlotte , Deltour Sandrine , Leger Anne , Rosso Charlotte , Pyatigorskaya Nadya , Rodriguez Regent Christine , Trystram Denis , Naggara Olivier , Seners Pierre , Turc Guillaume , Edjlali Myriam , Agbonon Rémi , Alotaibi Mohammed , Sonchet Antoine , Oppenheim Catherine , Meder Jean François , Benzakoun Joseph , Legrand Laurence , Fauché Cédric , Velasco Stéphane , Manceau Pierre François , Moulin Sebastien Solène Soize , Eugene François , Ferre Jean-Christophe , Paya Christophe , Eugene François , Gauvrit Jean-Yves , Langnier-Lemercier Sophie , Lassale Maria , Raoult helene , Ronziere thomas , Tracol Clément , Vannier Stéphane , Burel Julien , Le Moal Julien , Papagiannaki Chrysanthi , Aggour Mohamed , Sachet Marina , Boutet Claire , Beaujeux Remy , Hasiu Anca , Manisor Monica , Mihoc Dan , Kremer Stéphane , Arteaga Charles , Gazzola Sébastien , Darcourt Jean , Cognard Christophe , Bonneville Fabrice , Christine Januel Anne , Olivot Jean-Marc , Raposo Nicolas , Viguier Alain , Bibi Richard , Boustia Fakhreddine , Herbreteau Denis , Maldonado Igor , Narata Ana-Paula 
Published: May 2020

Background and Purpose:
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).

Methods:
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).

Results:

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 (
R
2
−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).

Conclusions:
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.