Skip to main content
Top
Published in: Irish Journal of Medical Science (1971 -) 6/2023

Open Access 16-02-2023 | Stroke | Original Article

The impact of the COVID-19 pandemic on the provision of endovascular thrombectomy for stroke: an Irish perspective

Authors: Conor Brosnan, David Brennan, Conor Reid, Sarah Power, Alan O’Hare, Paul Brennan, John Thornton, Matthew Crockett

Published in: Irish Journal of Medical Science (1971 -) | Issue 6/2023

Login to get access

Abstract

Background

The COVID-19 pandemic produced unprecedented challenges to healthcare systems. These challenges were amplified in the setting of endovascular thrombectomy (EVT) for large vessel occlusion strokes given the time-sensitive nature of the procedure.

Aims

To assess the impact of the COVID-19 pandemic on service provision at the primary endovascular stroke centre in Ireland.

Methods

A retrospective review of the National Thrombectomy Service database was performed. All patients undergoing EVT from 1 January to 31 December inclusive of 2019 to 2021 were included. Patient demographics, functional outcomes and endovascular treatment time metrics were recorded.

Results

Data from 2019, 2020 and 2021 were extracted. Three hundred seven thrombectomies were performed in 2019 and 2020; this number increased to 327 in 2021. Median time from arrival to groin puncture for thrombectomy was 64 min in 2019, increasing to 65 min in 2020. In 2021, this decreased to 52 min. Median time taken from groin puncture to first perfusion remained stable from 2019 to 2021 years at 20 min. Total duration of emergency thrombectomies reduced from 32 min in 2019 to 27 min in 2020. This increased to 29 min in 2021.

Conclusions

Despite the myriad of challenges presented by the pandemic, service provision at the primary Irish ESC, and the referring hospitals, has proven to be robust. Procedural time metrics were maintained whilst the expected reduction in number of EVTs performed did not materialise, there actually being a significant increase in number of EVTs performed in the pandemic’s second year.
Literature
2.
go back to reference Nannoni S, de Groot R, Bell S et al (2021) Stroke in COVID-19: a systematic review and meta-analysis. Int J Stroke 16(2):137–149CrossRefPubMed Nannoni S, de Groot R, Bell S et al (2021) Stroke in COVID-19: a systematic review and meta-analysis. Int J Stroke 16(2):137–149CrossRefPubMed
3.
go back to reference Badhiwala JH, Nassiri F, Alhazzani W et al (2015) Endovascular thrombectomy for acute ischemic stroke: a meta-analysis. JAMA 314(17):1832–1843CrossRefPubMed Badhiwala JH, Nassiri F, Alhazzani W et al (2015) Endovascular thrombectomy for acute ischemic stroke: a meta-analysis. JAMA 314(17):1832–1843CrossRefPubMed
4.
go back to reference Meretoja A, Keshtkaran M, Tatlisumak T et al (2017) Endovascular therapy for ischaemic stroke. Save a minute- save a week. Neurology 88(22):2123–27 Meretoja A, Keshtkaran M, Tatlisumak T et al (2017) Endovascular therapy for ischaemic stroke. Save a minute- save a week. Neurology 88(22):2123–27
5.
go back to reference Almekhlafi MA, Goyal M, Dippel DWJ et al (2021) Healthy life-year costs of treatment speed from arrival to endovascular thrombectomy in patients with ischemic stroke: a meta-analysis of individual patient data from 7 randomized clinical trials. JAMA Neurol 78(6):709–717CrossRefPubMed Almekhlafi MA, Goyal M, Dippel DWJ et al (2021) Healthy life-year costs of treatment speed from arrival to endovascular thrombectomy in patients with ischemic stroke: a meta-analysis of individual patient data from 7 randomized clinical trials. JAMA Neurol 78(6):709–717CrossRefPubMed
6.
go back to reference Farrell R, O’Keeffe A, O’Regan E (2020) First case of coronavirus confirmed in Republic of Ireland. Irish Independent Farrell R, O’Keeffe A, O’Regan E (2020) First case of coronavirus confirmed in Republic of Ireland. Irish Independent
7.
go back to reference Kennelly B, O’Callaghan M, Coughlan D et al (2020) The COVID-19 pandemic in Ireland: an overview of the health service and economic policy response. Health Policy Technol. 202;9(4):419–29 Kennelly B, O’Callaghan M, Coughlan D et al (2020) The COVID-19 pandemic in Ireland: an overview of the health service and economic policy response. Health Policy Technol. 202;9(4):419–29
8.
go back to reference Nguyen TN, Abdalkader M, Jovin TG et al (2020) Mechanical thrombectomy in the era of the COVID-19 pandemic: emergency preparedness for neuroscience teams: a guidance statement from the society of vascular and interventional neurology. Stroke 51(6):1896–1901CrossRefPubMed Nguyen TN, Abdalkader M, Jovin TG et al (2020) Mechanical thrombectomy in the era of the COVID-19 pandemic: emergency preparedness for neuroscience teams: a guidance statement from the society of vascular and interventional neurology. Stroke 51(6):1896–1901CrossRefPubMed
9.
go back to reference Qureshi A, Abd-Allah F, Al-Senani F et al (2020) Management of acute ischemic stroke in patients with COVID-19 infection: report of an international panel. Int J Stroke 15(5):540–554CrossRefPubMed Qureshi A, Abd-Allah F, Al-Senani F et al (2020) Management of acute ischemic stroke in patients with COVID-19 infection: report of an international panel. Int J Stroke 15(5):540–554CrossRefPubMed
10.
go back to reference Fraser JF, Arthur AS, Chen M et al (2020) Society of NeuroInterventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of COVID-19. J Neurointerv Surg 12(6):539–541CrossRefPubMed Fraser JF, Arthur AS, Chen M et al (2020) Society of NeuroInterventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of COVID-19. J Neurointerv Surg 12(6):539–541CrossRefPubMed
11.
go back to reference Leadership AASC (2020) Temporary emergency guidance to US stroke centers during the coronavirus disease 2019 (COVID-19) pandemic: on behalf of the American Heart Association/American Stroke Association Stroke Council Leadership. Stroke 51(6):1910–1912CrossRef Leadership AASC (2020) Temporary emergency guidance to US stroke centers during the coronavirus disease 2019 (COVID-19) pandemic: on behalf of the American Heart Association/American Stroke Association Stroke Council Leadership. Stroke 51(6):1910–1912CrossRef
12.
go back to reference Thornton J, McElroy S, Walsh R et al (2021) National thrombectomy service annual report 2021. In: HSE, editor Thornton J, McElroy S, Walsh R et al (2021) National thrombectomy service annual report 2021. In: HSE, editor
13.
go back to reference Alderson J, Nowlan N, Fitzpatrick J et al (2019) National thrombectomy service annual report 2019. In: HSE, editor Alderson J, Nowlan N, Fitzpatrick J et al (2019) National thrombectomy service annual report 2019. In: HSE, editor
14.
go back to reference Thornton J, McElroy S, Walsh R et al (2020) National thrombectomy service annual report 2020. In: HSE, editor Thornton J, McElroy S, Walsh R et al (2020) National thrombectomy service annual report 2020. In: HSE, editor
15.
go back to reference Goyal M, Menon BK, van Zwam WH et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387(10029):1723–1731CrossRefPubMed Goyal M, Menon BK, van Zwam WH et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387(10029):1723–1731CrossRefPubMed
16.
go back to reference Nogueira RG, Jadhav AP, Haussen DC et al (2018) Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 378:11–21CrossRefPubMed Nogueira RG, Jadhav AP, Haussen DC et al (2018) Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 378:11–21CrossRefPubMed
17.
go back to reference Venketasubramanian N, Anderson C, Ay H et al (2021) Stroke care during the COVID-19 pandemic: international expert panel review. Cerebrovasc Dis 50(3):245–261CrossRefPubMed Venketasubramanian N, Anderson C, Ay H et al (2021) Stroke care during the COVID-19 pandemic: international expert panel review. Cerebrovasc Dis 50(3):245–261CrossRefPubMed
18.
go back to reference Yoo AJ, Simonsen CZ, Prabhakaran S et al (2013) Cerebral Angiographic Revascularization Grading Collaborators. Refining angiographic biomarkers of revascularization: improving outcome prediction after intra-arterial therapy. Stroke 44(9):2509–012 Yoo AJ, Simonsen CZ, Prabhakaran S et al (2013) Cerebral Angiographic Revascularization Grading Collaborators. Refining angiographic biomarkers of revascularization: improving outcome prediction after intra-arterial therapy. Stroke 44(9):2509–012
19.
go back to reference Goyal M, Fargen KM, Turk AS et al (2014) 2C or not 2C: defining an improved revascularization grading scale and the need for standardization of angiography outcomes in stroke trials. J Neurointerv Surg 6(2):83–86CrossRefPubMed Goyal M, Fargen KM, Turk AS et al (2014) 2C or not 2C: defining an improved revascularization grading scale and the need for standardization of angiography outcomes in stroke trials. J Neurointerv Surg 6(2):83–86CrossRefPubMed
20.
go back to reference Turc G, Bhogal P, Fischer U et al (2019) European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg Turc G, Bhogal P, Fischer U et al (2019) European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg
21.
go back to reference Weisscher N, Vermeulen M, Roos YB et al (2008) What should be defined as good outcome in stroke trials; a modified Rankin score of 0–1 or 0–2? J Neurol 255(6):867–874CrossRefPubMed Weisscher N, Vermeulen M, Roos YB et al (2008) What should be defined as good outcome in stroke trials; a modified Rankin score of 0–1 or 0–2? J Neurol 255(6):867–874CrossRefPubMed
22.
go back to reference Wilson JTL, Hareendran A, Hendry A et al (2005) Reliability of the modified Rankin Scale across multiple raters: benefits of a structured interview. Stroke 36(4):777–781CrossRefPubMed Wilson JTL, Hareendran A, Hendry A et al (2005) Reliability of the modified Rankin Scale across multiple raters: benefits of a structured interview. Stroke 36(4):777–781CrossRefPubMed
23.
go back to reference Zhoa J, Li H, Kung D et al (2020) Impact of the COVID-19 epidemic on stroke care and potential solutions. Stroke 51(7):1996–2001CrossRef Zhoa J, Li H, Kung D et al (2020) Impact of the COVID-19 epidemic on stroke care and potential solutions. Stroke 51(7):1996–2001CrossRef
24.
go back to reference Rudilosso S, Laredo C, Vera V et al (2020) Acute stroke care is at risk in the era of COVID-19: experience at a comprehensive stroke center in Barcelona. Stroke 51:1991–1995CrossRefPubMed Rudilosso S, Laredo C, Vera V et al (2020) Acute stroke care is at risk in the era of COVID-19: experience at a comprehensive stroke center in Barcelona. Stroke 51:1991–1995CrossRefPubMed
25.
go back to reference Tiedt S, Bode FJ, Uphaus T et al (2020) Impact of the COVID-19-pandemic on thrombectomy services in Germany. Neurol Res Pract 2(44) Tiedt S, Bode FJ, Uphaus T et al (2020) Impact of the COVID-19-pandemic on thrombectomy services in Germany. Neurol Res Pract 2(44)
26.
go back to reference Kerleroux B, Fabacher T, Bricout N et al (2020) Mechanical thrombectomy for acute ischemic stroke amid the COVID-19 outbreak: decreased activity, and increased care delays. Stroke 51(7):2012–2017CrossRefPubMed Kerleroux B, Fabacher T, Bricout N et al (2020) Mechanical thrombectomy for acute ischemic stroke amid the COVID-19 outbreak: decreased activity, and increased care delays. Stroke 51(7):2012–2017CrossRefPubMed
Metadata
Title
The impact of the COVID-19 pandemic on the provision of endovascular thrombectomy for stroke: an Irish perspective
Authors
Conor Brosnan
David Brennan
Conor Reid
Sarah Power
Alan O’Hare
Paul Brennan
John Thornton
Matthew Crockett
Publication date
16-02-2023
Publisher
Springer International Publishing
Published in
Irish Journal of Medical Science (1971 -) / Issue 6/2023
Print ISSN: 0021-1265
Electronic ISSN: 1863-4362
DOI
https://doi.org/10.1007/s11845-023-03314-9

Other articles of this Issue 6/2023

Irish Journal of Medical Science (1971 -) 6/2023 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine