Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France.
Institut de Chirurgie Minime Invasive Guidée par l'Image, Strasbourg, France.
Eur J Neurol. 2020 Sep;27(9):1783-1787. doi: 10.1111/ene.14316. Epub 2020 Jun 3.
To date, no study has attempted to quantify the impact of the COVID-19 outbreak on the incidence and treatment of acute stroke.
This was a retrospective review of acute stroke pathway parameters in all three stroke units in the Alsace region during the first month of the outbreak (1-31 March 2020), using the similar period from 2019 as a comparator. A secondary detailed analysis of all stroke alerts and stroke unit admissions was performed in the centre with the largest case volume.
Compared to the same period in 2019, in March 2020 there were 39.6% fewer stroke alerts and 33.3% fewer acute revascularization treatments [40.9% less intravenous thrombolysis (IVT) and 27.6% less mechanical thrombectomy (MT)]. No marked variation was observed in the number of stroke unit admissions (-0.6%). The proportion of patients with acute revascularization treatments (IVT or MT) out of the total number of stroke unit admissions was significantly lower in March 2020 (21.3%) compared to 2019 (31.8%), P = 0.034. There were no significant differences in time delays or severity of clinical symptoms for patients treated by IVT or MT, nor in the distribution of final diagnosis amongst stroke alerts and stroke unit admissions.
These results suggest that the overall incidence of stroke remained the same, but fewer patients presented within the therapeutic time window. Increased public awareness and corrective measures are needed to mitigate the deleterious effects of the COVID-19 outbreak on acute stroke care.
迄今为止，尚无研究试图量化 COVID-19 爆发对急性脑卒中发病率和治疗的影响。
这是对阿尔萨斯地区三个卒中单元在疫情爆发的第一个月（2020 年 3 月 1 日至 31 日）的急性卒中通路参数的回顾性研究，使用 2019 年同期作为对照。在病例量最大的中心对所有卒中警报和卒中单元入院进行了二次详细分析。
与 2019 年同期相比，2020 年 3 月卒中警报减少了 39.6%，急性血管再通治疗减少了 33.3%[静脉溶栓（IVT）减少了 40.9%，机械血栓切除术（MT）减少了 27.6%]。卒中单元入院人数无明显变化（-0.6%）。2020 年 3 月，接受急性血管再通治疗（IVT 或 MT）的患者在卒中单元入院患者总数中的比例明显低于 2019 年（21.3%比 31.8%，P=0.034）。IVT 或 MT 治疗的患者的治疗时间延迟或临床症状严重程度以及卒中警报和卒中单元入院的最终诊断分布无显著差异。
这些结果表明，卒中的总体发病率保持不变，但接受治疗的患者进入治疗时间窗的人数减少。需要提高公众意识并采取纠正措施，以减轻 COVID-19 爆发对急性卒中治疗的不利影响。
