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Ischemic stroke
Original research
Endovascular thrombectomy time metrics in the era of COVID-19: observations from the Society of Vascular and Interventional Neurology Multicenter Collaboration
  1. Alexandra L Czap1,
  2. Alicia M Zha1,
  3. Jacob Sebaugh1,
  4. Ameer E Hassan2,3,
  5. Julie G Shulman4,
  6. Mohamad Abdalkader4,
  7. Thanh N Nguyen4,5,6,
  8. Italo Linfante7,
  9. Amy Kathryn Starosciak8,
  10. Santiago Ortega-Gutierrez9,
  11. Mudassir Farooqui9,
  12. Darko Quispe-Orozco9,
  13. Nirav A Vora10,
  14. Vivek Rai10,
  15. Raul G Nogueira11,
  16. Diogo C Haussen11,
  17. Dinesh V Jillella12,
  18. Ameena Rana13,
  19. Siyuan Yu13,
  20. Jesse M Thon14,
  21. Osama O Zaidat15,
  22. Priyank Khandelwal16,
  23. Ivo Bach16,
  24. Sunil A Sheth1,
  25. Ashutosh P Jadhav17,18,
  26. Shashvat M Desai17,18,
  27. Tudor G Jovin14,
  28. David S Liebeskind19,
  29. James E Siegler14
  1. 1 Neurology, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
  2. 2 Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
  3. 3 Clinical Neuroscience Research, Valley Baptist Medical Center, Harlingen, Texas, USA
  4. 4 Neurology, Boston Medical Center, Boston, Massachusetts, USA
  5. 5 Radiology, Boston Medical Center, Boston, Massachusetts, USA
  6. 6 Interventional Neuroradiology and Endovascular Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA
  7. 7 Department of Interventional Neuroradiology and Endovascular Neurosurgery, Baptist Health South Florida, Coral Gables, Florida, USA
  8. 8 Center for Outcomes Research, Baptist Health South Florida, Coral Gables, Florida, USA
  9. 9 Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  10. 10 Neuroscience Center, Riverside Methodist Hospital, Columbus, Ohio, USA
  11. 11 Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA
  12. 12 Neurology, Emory University, Atlanta, Georgia, USA
  13. 13 Cooper Medical School of Rowan University, Camden, New Jersey, USA
  14. 14 Cooper Neurological Institute, Cooper University Health Care, Camden, New Jersey, USA
  15. 15 Neuroscience Institute, Bons Secours Mercy Health St. Vincent Hospital, Toledo, Ohio, USA
  16. 16 Neurology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  17. 17 Neurology, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania, USA
  18. 18 Neurology, University of Pittsburgh Medical Center Presbyterian Medical Center, Pittsburgh, Pennsylvania, USA
  19. 19 Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
  1. Correspondence to Dr James E Siegler, Cooper Neurological Institute, Cooper University Health Care, Camden, NJ 08103-1489, USA; siegler.james{at}gmail.com

Abstract

Background Unprecedented workflow shifts during the coronavirus disease 2019 (COVID-19) pandemic have contributed to delays in acute care delivery, but whether it adversely affected endovascular thrombectomy metrics in acute large vessel occlusion (LVO) is unknown.

Methods We performed a retrospective review of observational data from 14 comprehensive stroke centers in nine US states with acute LVO. EVT metrics were compared between March to July 2019 against March to July 2020 (primary analysis), and between state-specific pre-peak and peak COVID-19 months (secondary analysis), with multivariable adjustment.

Results Of the 1364 patients included in the primary analysis (51% female, median NIHSS 14 [IQR 7–21], and 74% of whom underwent EVT), there was no difference in the primary outcome of door-to-puncture (DTP) time between the 2019 control period and the COVID-19 period (median 71 vs 67 min, P=0.10). After adjustment for variables associated with faster DTP, and clustering by site, there remained a trend toward shorter DTP during the pandemic (βadj=-73.2, 95% CI −153.8–7.4, Pp=0.07). There was no difference in DTP times according to local COVID-19 peaks vs pre-peak months in unadjusted or adjusted multivariable regression (βadj=-3.85, 95% CI −36.9–29.2, P=0.80). In this final multivariable model (secondary analysis), faster DTP times were significantly associated with transfer from an outside institution (βadj=-46.44, 95% CI −62.8 to – -30.0, P<0.01) and higher NIHSS (βadj=-2.15, 95% CI −4.2to – -0.1, P=0.05).

Conclusions In this multi-center study, there was no delay in EVT among patients treated for intracranial occlusion during the COVID-19 era compared with the pre-COVID era.

  • stroke
  • thrombectomy
  • COVID-19

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request, after clearance by the local ethics committee.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/neurintsurg-2020-017205

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    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request, after clearance by the local ethics committee.

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    Footnotes

    • Twitter @AlexandraCzap, @tele_Zha, @italolinfante, @NiravAVora, @diogohaussen, @dineshjillella, @ashupjadhav, @shashvatdesai, @JimSiegler

    • ALC and JES contributed equally.

    • Contributors AC and JS were responsible for the drafting and critical review of this manuscript. JS performed the statistical analyses. All authors were responsible for data collection at their respective sites. All authors have reviewed the manuscript, provided editorial feedback, and approve of its submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.