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  • Three-month functional outcomes following endovascular thrombectomy during the first wave of the COVID-19 pandemic: a Canadian single-center cohort study

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The pandemic and neurointervention
Three-month functional outcomes following endovascular thrombectomy during the first wave of the COVID-19 pandemic: a Canadian single-center cohort study
  1. Joel Neves Briard1,2,
  2. Gabrielle Dufort1,2,
  3. Grégory Jacquin1,2,
  4. Walid Alesefir1,2,
  5. Olena Bereznyakova1,2,
  6. William Boisseau3,4,
  7. Nicole Daneault1,2,
  8. Yan Deschaintre1,2,
  9. Jose Danilo Bengzon Diestro3,4,
  10. Célina Ducroux1,2,
  11. Johanna Eneling3,4,
  12. Laura Gioia1,2,
  13. Daniela E Iancu3,4,
  14. Céline Odier1,2,
  15. Jean Raymond3,4,
  16. Daniel Roy3,4,
  17. Christian Stapf1,2,
  18. Alain Weill3,4,
  19. Alexandre Y Poppe1,2
  1. 1 Neurosciences, Université de Montréal, Montreal, Quebec, Canada
  2. 2 Neurology, CHUM, Montreal, Quebec, Canada
  3. 3 Radiology, Université de Montréal, Montreal, Quebec, Canada
  4. 4 Radiology, CHUM, Montreal, Quebec, Canada
  1. Correspondence to Dr Alexandre Y Poppe, Neurosciences, Université de Montréal, Montreal, QC H3C 3J7, Canada; alexandre.poppe.med{at}ssss.gouv.qc.ca

Abstract

Background The COVID-19 pandemic has disrupted acute stroke care logistics, including delays in hyperacute management and decreased monitoring following endovascular therapy (EVT). We aimed to assess the impact of the pandemic on 90-day functional outcome among patients treated with EVT.

Methods This is an observational cohort study including all patients evaluated for an acute stroke between March 30, 2020 and September 30, 2020 (pandemic cohort) and 2019 (reference cohort) in a high-volume Canadian academic stroke center. We collected baseline characteristics, acute reperfusion treatment and management metrics. For EVT-treated patients, we assessed the modified Rankin score (mRS) at 90 days. We evaluated the impact of the pandemic on a 90-day favourable functional status (defined as mRS 0–2) and death using multivariable logistic regressions.

Results Among 383 and 339 patients included in the pandemic and reference cohorts, baseline characteristics were similar. Delays from symptom onset to evaluation and in-house treatment were longer during the early first wave, but returned to reference values in the subsequent months. Among the 127 and 136 EVT-treated patients in each respective cohort, favourable 90-day outcome occurred in 53/99 (53%) vs 52/109 (48%, p=0.40), whereas 22/99 (22%) and 28/109 (26%, p=0.56) patients died. In multivariable regressions, the pandemic period was not associated with 90-day favourable functional status (aOR 1.27, 95% CI 0.60 to 2.56) or death (aOR 0.74, 95% CI 0.33 to 1.63).

Conclusion In this single-center cohort study conducted in a Canadian pandemic epicenter, the first 6 months of the COVID-19 pandemic did not impact 90-day functional outcomes or death among EVT-treated patients.

  • COVID-19
  • stroke
  • intervention
  • thrombectomy

Data availability statement

Data are available upon reasonable request by a qualified investigator.

This article is made freely available for personal 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-2021-017664

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    Data availability statement

    Data are available upon reasonable request by a qualified investigator.

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    Footnotes

    • Twitter @JNevesBriard, @docd88

    • Contributors JNB: Conceptualized and designed the study, collected and analyzed the data, drafted the manuscript. CD, GD: Collected and analyzed the data, drafted the manuscript. GJ: Collected and analyzed the data, reviewed the manuscript for intellectual content. WA, OB, WB, ND, YD, JDBD, JE, LG, DEI, CO, JR, DR, CS, AW: Reviewed the manuscript for intellectual content. AYP: Conceptualized and designed the study, analyzed the data, revised the manuscript, supervised the project.

    • 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.