Management of endovascular therapy for acute ischemic stroke amid the COVID-2019 pandemic: a multicenter survey in China

ABSTRACT

Objectives: The impact of COVID-19 pandemic on endovascular therapy (EVT) for acute ischemic stroke in China is unknown. This study was aimed to verify the volume change of EVT for acute ischemic stroke affected by COVID-19 and its potential factors.

Methods: This cross-sectional study was conducted via an online questionnaire survey in China. The questionnaire was mainly composed of descriptive information, volume change of EVT for acute ischemic stroke, and the protection status of medical staff.

Results: A total of 103 stroke physicians in 28 provinces across China completed the survey questionnaire. A volume decline in EVT for acute stroke occurred in 93 (90.3%) hospitals after lockdown (23 January 2020). Nearly half of the hospitals (51/103, 49.5%) experienced a volume decline of EVT case more than 50% and 14 (13.6%) hospitals completely ceased offering EVT. Hospitals with decline >50% of EVT case had higher proportion of hospitals with a designated area for COVID-19 screening in the emergency room (44/51, 86.3% vs 34/52, 65.4%, p= 0.01) and medical staff in quarantine (19/51, 37.3% vs 7/52, 13.5%, p< 0.01), with lower proportion of hospitals with personal protective equipment protocol (41/51, 80.4% vs 49/52, 94.2%, p= 0.03) than hospitals with decline ≤50%.

Conclusions: The volume of EVT for acute ischemic stroke severely declined after lockdown in China. Designating a specific area for COVID-19 screening, insufficient personal protection and understaffing may exacerbate the volume decline of EVT.

KEYWORDS:

• COVID-19
• stroke
• endovascular therapy
• algorithm
• pandemic

Acknowledgments

We thank all the participants of this survey, especially for their valuable contributions to the fight against COVID-19.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

ZM, LL, and DL conceived and designed the study. GP and XN contributed to data collection and performed statistical analysis. All authors contributed to data interpretation. GP wrote the draft of the manuscript. LL and DL revised the manuscript. ZM takes responsibility for the paper as a whole.

Additional information

Notes on contributors

Guangge Peng

Guangge Peng is an MD student of Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. She mainly focuses on endovascular therapy for ischemic stroke.

Ximing Nie

Ximing Nie is a fellow of Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. He mainly focuses on cerebrovascular disease.

David Liebeskind

David Liebeskind is a professor of Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California, Los Angeles, CA, USA. He has published widely on the field of cerebrovascular disease, especially stroke imaging.

Liping Liu

Liping Liu is a professor of Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. She has published widely on the field of cerebrovascular disease and neurological intensive care.

Zhongrong Miao

Zhongrong Miao is a professor of Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. He has published widely on the field of endovascular therapy for ischemic stroke.