School of Medicine Publications and Presentations
Document Type
Article
Publication Date
2-8-2021
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 statespecific 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 67min, 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.
Recommended Citation
Czap, A. L., Zha, A. M., Sebaugh, J., Hassan, A. E., Shulman, J. G., Abdalkader, M., Nguyen, T. N., Linfante, I., Starosciak, A. K., Ortega-Gutierrez, S., Farooqui, M., Quispe-Orozco, D., Vora, N. A., Rai, V., Nogueira, R. G., Haussen, D. C., Jillella, D. V., Rana, A., Yu, S., Thon, J. M., … Siegler, J. E. (2021). Endovascular thrombectomy time metrics in the era of COVID-19: observations from the Society of Vascular and Interventional Neurology Multicenter Collaboration. Journal of neurointerventional surgery, neurintsurg-2020-017205. Advance online publication. https://doi.org/10.1136/neurintsurg-2020-017205
Publication Title
Journal of NeuroInterventional Surgery
DOI
10.1136/neurintsurg-2020-017205
Academic Level
faculty
Mentor/PI Department
Neurology
Comments
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.