Neuroradiology Department, CH Sainte-Anne, Paris, France (B.K., W.B.H., G.B.).
Public Health, CHRU Strasbourg, France (T.F.).
Stroke. 2020 Jul;51(7):2012-2017. doi: 10.1161/STROKEAHA.120.030373. Epub 2020 May 20.
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).
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).
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]; <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; <0.001 in 2019) and in transferred patients (mean 182.6±SD 82.0 minutes versus 153.25±67; <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 ( -0.51; =0.04). Patients treated during the COVID outbreak were less likely to receive intravenous thrombolysis and to have unwitnessed strokes (both <0.05).
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.
在 2019 年冠状病毒病（COVID-19）大流行期间，院前救治链反应效率和医院资源充足性受到挑战，这可能对适合机械取栓（MT）的缺血性脑卒中患者产生不良影响。
我们对接受 MT 治疗的患者进行了一项前瞻性的全国范围的数据收集，时间范围为 45 天，涵盖了 COVID-19 防控措施实施期间和 2019 年同期接受治疗的患者。主要终点是疫情期间接受 MT 治疗的患者数量变化。次要终点包括发病、影像学检查和腹股沟穿刺之间的治疗延迟。为了分析主要终点，我们使用泊松回归模型。然后，我们使用皮尔逊相关系数（与零值相比）分析 MT 数量与 COVID-19 住院患者数量之间的相关性。
在所有法国行政区域的 32 个中心共纳入了 1513 名患者。在疫情期间，MT 治疗病例数显著下降 21%（0.79；[95%置信区间，0.76-0.82]；<0.001），并且影像学检查和腹股沟穿刺之间的延迟时间整体上显著增加（平均 144.9±86.8 分钟与 126.2±70.9 分钟；2019 年<0.001）和转院患者（平均 182.6±82.0 分钟与 153.25±67 分钟；<0.001）。在严格的疫情缓解措施实施后，COVID 住院患者数量与 MT 治疗病例数之间呈显著负相关（-0.51；=0.04）。在 COVID 爆发期间接受治疗的患者更不可能接受静脉溶栓治疗和出现无人见证的脑卒中（均<0.05）。
我们的研究表明，法国 COVID-19 大流行的早期阶段，接受 MT 治疗的患者数量显著减少，且治疗延迟时间显著延长。这些发现促使人们立即考虑在 COVID-19 大流行演变的不同情况下，做好当地和区域脑卒中网络的准备工作。
