Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak in France: Decreased Activity, and Increased Care Delays

Background: The efficiency of pre-hospital care chain response and the adequacy of hospital resources are challenged amid the Coronavirus disease 2019 (COVID-19) outbreak, with suspected consequences for patients with ischemic stroke eligible for mechanical thrombectomy (MT). Methods: We conducted a prospective national level data collection of patients treated with MT, ranging 45 days across epidemic containment measures instatement, and of patients treated during the same calendar period in 2019.The primary endpoint was the variation of patients receiving MT during the epidemic period. Secondary endpoints included care delays between onset, imaging and groin puncture. To analyze the primary endpoint, we used a Poisson regression model. We then analyzed the correlation between the number of MTs and the number of COVID-19 cases hospitalizations, using the Pearson correlation coefficient (compared to the null value). Findings: A total of 1513 patients were included at 32 centers, in all French administrative regions. There was a 21% significant decrease (0.79; 95%CI [0.76 - 0.82]; p<0.001) in MT case volumes during the epidemic period, and a significant increase in delays between imaging and groin puncture, overall (mean 126.2 ±SD 70.9 minutes vs 144.9±86.8; p<0.001 in 2019) and in transferred patients (mean 182.6 ± SD 82.0 minutes vs 153.25 ± 67).After the instatement of strict epidemic mitigation measures, there was a significant negative correlation between the number of hospitalizations for COVID and the number of MT cases (R² -0.51; p=0.04). Patients treated during the COVID outbreak were less likely to receive i.v. thrombolysis, and to have unwitnessed strokes (both p<0.05). Interpretation: Our study showed a significant decrease in patients treated with MTs during the first stages of the COVID epidemic in France, and alarming indicators of lengthened care delays. These findings prompt immediate consideration of local and regional stroke networks preparedness in the varying contexts of COVID19 pandemic evolution. Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: As for all non-interventional studies of de-identified data in France, written informed consent was waived and a commitment to compliance (Reference Methodology CPMR-4, #2217365) was filed to the French National Information Science and Liberties Commission / National Institute for Healthcare data prior to data centralization, in respect to the General Data Protection Regulation. Patients or proxies were informed they could oppose the use of their data. This report was prepared according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.