2019冠状病毒病大流行对急性缺血性卒中机械取栓及桥接治疗的不同影响
Differential Influence of the COVID-19 Pandemic on Mechanical Thrombectomy and Bridging Therapy for Acute Ischemic Stroke.
作者信息
Geng Dandan, Xu Xueqian, Luan Xiaoqian, Qiu Linan, Chen Liuzhu, Chen Jiahao, Wu Beilan, Xu Minjie, Ergashev Akmal, Tang Wenjie, Li Jia
机构信息
Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Wenzhou Medical University School of Mental Health, Wenzhou, China.
出版信息
Front Neurol. 2022 Mar 22;13:852423. doi: 10.3389/fneur.2022.852423. eCollection 2022.
BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic is having a dramatic impact on acute stroke care. Its effects may accompany stroke care for a long time. We compared the treatment, short-term and long-term functional outcomes of patients with AIS from 2019 to 2020. Our objective was to evaluate the effect of COVID-19 epidemic on mechanical thrombectomy (MT) in patients in our hospital.
METHODS
We collected information on subjects treated with MT in 2019-2020, including age, sex, time from the onset to arterial sheath insertion, time from the onset to recanalization, the rate of lung infection and hemorrhagic transformation, modified Rankin scale (mRS), NHISS, and ASPECTS.
RESULTS
The number of patients with MT decreased significantly by 26.6% in 2020 ( = 0.025). The pretreatment ASPECTS score for 2020 was significantly higher than 2019 ( = 0.004). Besides, the patients were more likely to develop lung infection (65 vs. 54.1%, = 0.042) and had a higher risk of hemorrhagic transformation (47.4% vs. 30.4%, = 0.005) in 2019. The discharged mRS reflected the worse short-term functional prognosis of patients with MT in 2019 (66 vs. 44.9%, = 0.046). In the subgroup analysis of bridging thrombolysis (BT), more patients with BT are expected to have a poor short-term functional prognosis in 2020, according to the discharged mRS (62.5 vs. 37.5%, = 0.024). However, there was no difference in mRS at 180 days between the two groups ( = 0.094).
CONCLUSION
For patients with MT, both short- and long-term functional outcomes were not significantly affected due to the mild condition of patients admitted to hospital in 2020. For patients with BT, the COVID-19 pandemic has prolonged the green channel time of stroke, leading to a poor short-term functional prognosis of patients with stroke in the pandemic period. There was no difference in the effectiveness of direct MT and BT during the COVID-19 pandemic.
背景
2019冠状病毒病（COVID-19）大流行正在对急性卒中治疗产生巨大影响。其影响可能会伴随卒中治疗很长时间。我们比较了2019年至2020年急性缺血性卒中（AIS）患者的治疗情况、短期和长期功能结局。我们的目的是评估COVID-19疫情对我院患者机械取栓（MT）的影响。
方法
我们收集了2019 - 2020年接受MT治疗的受试者的信息，包括年龄、性别、从发病到动脉鞘置入的时间、从发病到再通的时间、肺部感染率和出血转化情况、改良Rankin量表（mRS）、美国国立卫生研究院卒中量表（NHISS）和脑梗死溶栓治疗前评估量表（ASPECTS）。
结果
2020年接受MT治疗的患者数量显著减少了26.6%（P = 0.025）。2020年治疗前的ASPECTS评分显著高于2019年（P = 0.004）。此外，2019年患者更易发生肺部感染（65%对54.1%，P = 0.042）且出血转化风险更高（47.4%对30.4%，P = 0.005）。出院时的mRS显示2019年接受MT治疗的患者短期功能预后更差（66%对44.9%，P = 0.046）。在桥接溶栓（BT）亚组分析中，根据出院时的mRS，预计2020年更多接受BT治疗的患者短期功能预后较差（62.5%对37.5%，P = 0.024）。然而，两组在180天时的mRS无差异（P = 0.094）。
结论
对于接受MT治疗的患者，由于2020年入院患者病情较轻，短期和长期功能结局均未受到显著影响。对于接受BT治疗的患者，COVID-19大流行延长了卒中的绿色通道时间，导致大流行期间卒中患者短期功能预后较差。在COVID-19大流行期间，直接MT和BT的有效性没有差异。
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