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Acute Stroke Management During the COVID-19 Pandemic: Does Confinement Impact Eligibility for Endovascular Therapy?
Stroke ( IF 8.3 ) Pub Date : 2020-07-01 , DOI: 10.1161/strokeaha.120.030794
Steven D Hajdu 1 , Valerie Pittet 2 , Francesco Puccinelli 1 , Wagih Ben Hassen 3 , Malek Ben Maacha 4 , Raphaël Blanc 4 , Sandra Bracco 5 , Gabriel Broocks 6 , Bruno Bartolini 1 , Tommaso Casseri 5 , Frederic Clarençon 7 , Olivier Naggara 3 , François Eugène 8 , Jean-Christophe Ferré 8 , Alexis Guédon 9 , Emmanuel Houdart 9 , Timo Krings 10 , Pierre Lehmann 11 , Nicola Limbucci 12 , Paolo Machi 13 , Juan Macho 14 , Nicolo Mandruzzato 13 , Sergio Nappini 12 , Marie Teresa Nawka , Patrick Nicholson 6, 10 , João Pedro Marto 15 , Vitor Pereira 10 , Manuel A Correia 16 , Teresa Pinho-E-Melo 16 , João Nuno Ramos 15 , Eytan Raz 17 , Patrícia Ferreira 18 , João Reis 18 , Maksim Shapiro 17 , Eimad Shotar 7 , Noel van Horn 6 , Michel Piotin 4 , Guillaume Saliou 1
Affiliation  

During the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended measures to mitigate the outbreak such as social distancing and confinement. Since these measures have been put in place, anecdotal reports describe a decrease in the number of endovascular therapy (EVT) treatments for acute ischemic stroke due to large vessel occlusion. The purpose of our study was to determine the effect on EVT for patients with acute ischemic stroke during the COVID-19 confinement. In this retrospective, observational study, data were collected from November 1, 2019, to April 15, 2020, at 17 stroke centers in countries where confinement measures have been in place since March 2020 for the COVID-19 pandemic (Switzerland, Italy, France, Spain, Portugal, Germany, Canada, and United States). This study included 1600 patients treated by EVT for acute ischemic stroke. Date of EVT and symptom onset-to-groin puncture time were collected. Mean number of EVTs performed per hospital per 2-week interval and mean stroke onset-to-groin puncture time were calculated before confinement measures and after confinement measures. Distributions (non-normal) between the 2 groups (before COVID-19 confinement versus after COVID-19 confinement) were compared using 2-sample Wilcoxon rank-sum test. The results show a significant decrease in mean number of EVTs performed per hospital per 2-week interval between before COVID-19 confinement (9.0 [95% CI, 7.8–10.1]) and after COVID-19 confinement (6.1 [95% CI, 4.5–7.7]), (P<0.001). In addition, there is a significant increase in mean stroke onset-to-groin puncture time (P<0.001), between before COVID-19 confinement (300.3 minutes [95% CI, 285.3–315.4]) and after COVID-19 confinement (354.5 minutes [95% CI, 316.2–392.7]). Our preliminary analysis indicates a 32% reduction in EVT procedures and an estimated 54-minute increase in symptom onset-to-groin puncture time after confinement measures for COVID-19 pandemic were put into place.

中文翻译:

COVID-19大流行期间的急性中风管理:禁闭会影响血管内治疗的资格吗?

在2019年冠状病毒病(COVID-19)大流行期间,世界卫生组织(World Health Organization)建议了缓解疾病爆发的措施,例如社会隔离和隔离。由于已经采取了这些措施,因此有传闻报道描述了由于大血管阻塞导致的针对急性缺血性中风的血管内治疗(EVT)治疗数量的减少。我们研究的目的是确定在COVID-19禁闭期间对急性缺血性卒中患者的EVT的影响。在这项回顾性观察性研究中,数据收集自2019年11月1日至2020年4月15日在2020年3月以来针对COVID-19大流行(瑞士,意大利,法国,西班牙,葡萄牙,德国,加拿大和美国)。该研究包括1600例接受EVT治疗的急性缺血性中风患者。收集EVT日期和症状发作至腹股沟穿刺时间。在分娩措施之前和分娩措施之后,计算每家医院每2周间隔进行EVT的平均次数以及中风发作到腹股沟的平均穿刺时间。使用2样本Wilcoxon秩和检验比较了两组之间的分布(非正态)(在COVID-19封闭之前与COVID-19封闭之后)。结果显示,在COVID-19分娩之前(9.0 [95%CI,7.8-10.1])和COVID-19分娩之后(6.1 [95%CI, 4.5–7.7]),(在分娩措施之前和分娩措施之后,计算每家医院每2周间隔进行EVT的平均次数以及中风发作到腹股沟的平均穿刺时间。使用2样本Wilcoxon秩和检验比较了两组之间的分布(非正态)(在COVID-19封闭之前与COVID-19封闭之后)。结果显示,在COVID-19分娩之前(9.0 [95%CI,7.8-10.1])和COVID-19分娩之后(6.1 [95%CI, 4.5–7.7]),(在分娩措施之前和分娩措施之后,计算每家医院每2周间隔进行EVT的平均次数以及中风发作到腹股沟的平均穿刺时间。使用2样本Wilcoxon秩和检验比较了两组之间的分布(非正态)(在COVID-19封闭之前和COVID-19封闭之前)。结果显示,在COVID-19分娩之前(9.0 [95%CI,7.8-10.1])和COVID-19分娩之后(6.1 [95%CI, 4.5–7.7]),(使用2样本Wilcoxon秩和检验比较了两组之间的分布(非正态)(在COVID-19封闭之前和COVID-19封闭之前)。结果显示,在COVID-19分娩之前(9.0 [95%CI,7.8-10.1])和COVID-19分娩之后(6.1 [95%CI, 4.5–7.7]),(使用2样本Wilcoxon秩和检验比较了两组之间的分布(非正态)(在COVID-19封闭之前和COVID-19封闭之前)。结果显示,在COVID-19分娩之前(9.0 [95%CI,7.8-10.1])和COVID-19分娩之后(6.1 [95%CI, 4.5–7.7]),(P <0.001)。此外,在COVID-19禁闭之前(300.3分钟[95%CI,285.3–315.4])和COVID-19禁闭之后(平均),中风发作至腹股沟穿刺时间显着增加(P <0.001)。 354.5分钟[95%CI,316.2–392.7]。我们的初步分析表明,在采取针对COVID-19大流行的隔离措施后,EVT程序减少了32%,症状发作到腹股沟穿刺的时间估计增加了54分钟。
更新日期:2020-07-28
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