Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak

Basile Kerleroux (1) , Thibaut Fabacher (2) , Nicolas Bricout (3) , Martin Moïse (3) , Benoit Testud (4) , Sivadji Vingadassalom (4) , Héloïse Ifergan (5) , Kévin Janot (5) , Arturo Consoli (6, 7) , Wagih Ben Hassen (1) , Eimad Shotar (8) , Julien Ognard (9) , Guillaume Charbonnier (10) , Vincent L’allinec (11) , Alexis Guédon (12) , Federico Bolognini (13) , Gaultier Marnat (14) , Géraud Forestier (15) , Aymeric Rouchaud (15) , Raoul Pop (16) , Nicolas Raynaud (17) , François Zhu (7, 18) , Jonathan Cortese (19) , Vanessa Chalumeau (19) , Jérome Berge (14) , Simon Escalard (20) , Grégoire Boulouis (1) , Cyril Chivot , Riyad Hanafi , Anne Pasco , Jean-Baptiste Girot , Alessandra Biondi , Fortunato Di Caterino , Panagiotis Primikiris , Giovanni Vitale , Louise Bonnet , Florent Gariel , Xavier Barreau , Sabrina Debruxelles , Ludovic Lucas , Patrice Menegon , Stéphane Olindo , Mathilde Poli , Pauline Renou , Sharmila Sagnier , Igor Sibon , Louis Veunac , Jean-Christophe Gentric , Charlotte Barbier , Marion Boulanger , Julien Cogez , Sophie Guettier , Romain Schneckenburger , Emmanuel Touze , Mariette Delaitre , Pablo Lebendinsky , Mariano Musacchio , Frédéric Ricolfi , Pierre Thouant , François Caparros , Barbara Casolla , Lucie Della Schiava , Nelly Dequatre , Hilde Henon , Marco Pasi , Apolline Kazemi , Fouzi Bala , Laurent Estrade , Charbel Mounayer , Susanna Saleme , Francisco Macian-Montoro , Omer Eker , François Cotton , Karine Blanc-Lasserre , Serkan Cakmak , Tae-Hee Cho , Laurent Derex , Anne-Claire Lukaszewicz , Laura Mechtouff , Norbert Nighoghossian , Frédéric Philippeau , Roberto Riva , Francis Turjman , Anne-Evelyne Vallet , Xavier Carle , Philippe Dory-Lautrec , Anthony Reyre , Jean-François Hak , Hervé Brunel , Amel Benali , François-Louis Collemiche , Cyril Dargazanli , Frederico Cagnazzo , Imad Derraz , Caroline Arquizan , Lucas Corti , Vincent Costalat , Nicolas Gaillard , Grégory Gascou , Pierre-Henri Lefèvre , Isabelle Mourand , Carlos Riquelme , Anne Laure Derelle , Benjamin Gory (18, 7) , Liang Liao , Romain Tonnelet , René Anxionnat (18, 7) , Mathieu Bonnerot , Serge Bracard (18, 7) , Marc Braun (7, 21) , Lisa Humbertjean , Jean-Christophe Lacour , Gioia Mione , Sophie Planel , Sébastien Richard , Nolwenn Riou-Comte , Emmanuelle Schmitt , Romain Bourcier , Lili Detraz , Hubert Desal , Pierre-Louis Alexandre , Benjamin Daumas-Duport , Cédric Lenoble , Monica Roy , Oghuzan Coskun , Frederico Di Maria , Bertrand Lapergue , Georges Rodesch , Adrien Wang , David Weisenburger-Lile , Sergio Zimatore , Nadia Ajili , Géraldine Buard , Serge Evrard , Lucas Gorza , Julie Gratieux , Morgan Leguen , Sylvie Marinier , Fernando Pico , Roxanna Poll , Haja Rakotoharinandrasana , Philippe Tassan , Maya Tchikviladze , François Delvoye , Solène Hebert , Raphaël Blanc , Gabriele Ciccio , Jean-Philippe Desilles , Benjamin Maier , Mikael Mazighi , Michel Piotin , Hocine Redjem , Stanislas Smajda , Malek Ben Maacha , Ovide Corabianu , Thomas de Broucker , Olivier Ille , Eric Manchon , Michael Obadia , Mickael Obadia , Igor Raynouard , Roxanne Peres , Candice Sabben , Didier Smadja , Guillaume Taylor , Laurie-Anne Thion , Augustin Lecler , Christian Denier , Jildaz Caroff , Olivier Chassin , Laurent Spelle , Laura Venditti , Armand Aymard , Jean Betty , Vittorio Civelli , Michael Eliezer , Matteo Fantoni , Emmanuel Houdart , Marc-Antoine Labeyrie , Jean-Pierre Saint Maurice , Erwah Kalsoum , Aurelien Pacini , Chawkat Ramadane , Titien Tuilier , Adrien Villain , Frédéric Clarencon , Vincent Degos , Ahmed Elhfnawy , Mahmoud Elhorany , Stéphanie Lenck , Kevin Premat , Nader-Antoine Sourour , Sonia Alamowitch , Flore Baronnet , Sophie Crozier , Sandrine Deltour , Anne Leger , Charlotte Rosso , Nadya Pyatigorskaya , Christine Rodriguez Regent , Denis Trystram , Olivier Naggara , Pierre Seners , Guillaume Turc , Myriam Edjlali , Rémi Agbonon , Mohammed Alotaibi , Antoine Sonchet , Catherine Oppenheim , Jean François Meder , Joseph Benzakoun , Laurence Legrand , Cédric Fauché , Stéphane Velasco , Pierre François Manceau , Sebastien Solène Soize Moulin , Jean-Christophe Ferré , Christophe Paya , François Eugene , Jean-Yves Gauvrit , Sophie Langnier-Lemercier , Maria Lassale , Helene Raoult , Thomas Ronziere , Clément Tracol , Stéphane Vannier , Julien Burel , Julien Le Moal , Chrysanthi Papagiannaki , Mohamed Aggour , Marina Sachet , Claire Boutet , Remy Beaujeux , Anca Hasiu , Monica Manisor , Dan Mihoc , Stéphane Kremer , Charles Arteaga , Sébastien Gazzola , Jean Darcourt , Christophe Cognard , Fabrice Bonneville , Anne Christine Januel , Jean-Marc Olivot , Nicolas Raposo , Alain Viguier , Richard Bibi , Fakhreddine Boustia , Denis Herbreteau , Igor Lima Maldonado , Ana-Paula Narata

1 Service de neuroradiologie [Paris]
2 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
3 Service de neuroradiologie [Lille]
4 Service de neuroradiologie diagnostique et interventionnelle
5 Service de neuroradiologie [Tours]
6 Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch]
7 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
8 CHU Pitié-Salpêtrière [AP-HP]
9 Service de Neuroradiologie [Brest]
10 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
11 CHU Angers - Centre Hospitalier Universitaire d'Angers
12 Hôpital Lariboisière-Fernand-Widal [APHP]
13 Service de Neurologie [Hôpitaux Civils de Colmar]
14 DNR - Bordeaux - Département de Neuro-Radiologie [Bordeaux]
15 Service de Neuroradiologie interventionnelle [CHU Limoges]
16 Département de Neuroradiologie [Strasbourg]
17 Service de neurologie [Poitiers]
18 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
19 Service de Neuroradiologie [CHU de Bicêtre]
20 CHU Rothschild [AP-HP]
21 Faculté de Médecine [Nancy]

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.

Domaines: Médecine humaine et pathologie

Basile Kerleroux, Thibaut Fabacher, Nicolas Bricout, Martin Moïse, Benoit Testud, et al.. Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak. Stroke, 2020, 51 (7), pp.2012-2017. ⟨10.1161/STROKEAHA.120.030373⟩. ⟨hal-03224097⟩