Impact on Clinical Outcomes of Changes in the Practice of Mechanical Thrombectomy due to the COVID-19 Pandemic

Objective: To evaluate whether changes in the practice of mechanical thrombectomy could affect the clinical outcomes during the coronavirus disease (COVID-19) pandemic.

Methods: Patients who underwent mechanical thrombectomy from April 2019 to March 2021 for anterior circulation proximal large artery occlusion in our institute were divided into two groups of pre- and post-COVID-19, with April 2020 assumed to be the start of the COVID-19 era with the first declaration of a state of emergency. We compared patient characteristics, proportions of patient selection depending on rapid processing of perfusion and diffusion (RAPID) CT perfusion, outcomes including treatment variables such as time and reperfusion status, and patient independence at 3 months.

Results: Data for 112 patients (median age, 79 years; 44 females) were included in the analysis. A total of 50 patients were assigned to the pre-COVID-19 group (45%). More patients were selected with RAPID CT perfusion in the post-COVID-19 compared with the pre-COVID-19 (69% vs. 16%; P <0.001). Treatment details and clinical outcomes did not differ between the groups, including the door-to-puncture time (median [interquartile range], 66 [54-90] min vs. 74 [61-89] min; P = 0.15), proportions of significant reperfusion (82% vs. 87%; P = 0.60), and modified Rankin scale score of ≤2 at 3 months (46% vs. 45%; P >0.99). Multivariate logistic regression analysis for the clinical outcome of modified Rankin scale score of ≤2 at 3 months was performed and included the following factors: age, sex, the onset-to-door time, significant reperfusion, and pre- and post-COVID-19. The treatment period did not influence the outcomes (post-COVID-19 group, odds ratio, 0.79; 95% confidence interval, 0.34-1.85, P = 0.59).

Conclusion: In the setting of a limited access to emergency MRI during the COVID-19 pandemic, RAPID CT perfusion was performed significantly more often. Changes in the practice of mechanical thrombectomy with the protected code stroke did not bring the different level of treatment and clinical outcomes as before.