Abstract
Background and purposeThe purpose of our study was to analyse endovascular treatment (EVT) in patients presenting acute anterior circulation ischemic stroke with large-vessel occlusion (AIS-LVO) during the pandemic and post-epidemic periods.MethodsPatients with AIS-LVO of the anterior circulation who underwent EVT were enrolled. According to the times of Wuhan closure and reopening, patients were divided into a pre-pandemic group (from November 8, 2019, to January 22, 2020), pandemic group (from January 23, 2020, to April 8, 2020) and post-epidemic group (from April 9, 2020, to June 24, 2020). The primary endpoints were the time delay among symptom onset to arriving hospital door, to groining puncture and to vascular reperfusion. Secondary endpoints were the functional outcomes evaluated by 90-day modified Rankin scale (mRS) score.ResultsIn total, the times from onset to reperfusion (OTR, median 356 min vs. 310 min, p = 0.041) and onset to door (OTD, median 238 min vs. 167 min, p = 0.017) were prolonged in the pandemic group compared to the pre-pandemic group, and the delay continue in the post-epidemic period. In the subgroup analysis, the time from door to imaging (DTI) was significantly prolonged during the pandemic period. Interestingly, the prolonged DTI was corrected in the directly admitted subgroup during post-epidemic period. In addition, the functional outcomes showed no significant differences across the three periods.ConclusionsTotal time and prehospital time were prolonged during the pandemic and post-epidemic periods. Urgent public education and improved in-hospital screening processes are necessary to decrease time delays.
Highlights
Since the first case of the novel coronavirus disease 2019 (COVID-19) patient was reported in Wuhan, China in December 2019, the COVID-19 has become a global pandemic [1, 2]
The pandemic group had a lower rate of hypertension than the pre-pandemic group (43.5% vs. 71.9%, p = 0.034) and post-epidemic group (43.5% vs. 74.4%, p = 0.015)
In the subgroup of patients transferred from other institutions (Table 2, Fig. 2C), similar to the whole cohort, the total time (OTR) and the time from stroke onset to PCS door were significantly prolonged in the pandemic group and post-epidemic group, compared with the pre-pandemic group
Summary
Since the first case of the novel coronavirus disease 2019 (COVID-19) patient was reported in Wuhan, China in December 2019, the COVID-19 has become a global pandemic [1, 2]. A few studies reported that the number of acute anterior circulation ischemic stroke with large-vessel occlusion (AIS-LVO) patients who underwent endovascular treatment (EVT) decreased and the time from stroke onset to puncture (OTP) was significantly prolonged [5,6,7,8,9,10,11,12]. The standardization of outbreak prevention measures may complicate the medical process, which may lead to delays in AIS-LVO patients. The purpose of our study was to analyse endovascular treatment (EVT) in patients presenting acute anterior circulation ischemic stroke with large-vessel occlusion (AIS-LVO) during the pandemic and post-epidemic periods
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