Impact of COVID-19 pandemic on a regional stroke thrombectomy service in the United Kingdom

Introduction: We examined the impact of the COVID-19 pandemic on our regional stroke thrombectomy service in the UK. Methods: This was a single-centre health service evaluation. We began testing for COVID-19 on 3 March and introduced a modified “COVID Stroke Thrombectomy Pathway” on 18 March. We included 61 consecutive stroke thrombectomy patients admitted between 1 January and 30 April, and analyzed data on patient demographics, thrombectomy procedures, thrombectomy pathway time-points, and early neurological outcomes. We compared the data for January and February (“pre-COVID”, n=33) vs. March and April (“during COVID”, n=28). Results: Patient demographics were similar between the two groups (mean age 71±12.8 years, 39% female). During the COVID-19 pandemic, a) total stroke admissions fell by 17% but the stroke thrombectomy rate was maintained at 17%; b) successful recanalization rate was maintained at 81%; c) early neurological outcomes (neurological improvement following thrombectomy and inpatient mortality) were not significantly different; d) use of general anesthesia fell significantly from 85% to 32% as intended; and e) time intervals from onset to arrival, groin puncture, and recanalization were not significantly different, whereas internal delays for external referrals were significantly reduced for door-to-groin puncture [48 (IQR 39-57) vs. 33 (IQR 27-44) minutes, p=.013] and door-to-recanalization [82·5 (IQR 61-110) vs. 60 (IQR 55-70) minutes, p=.018]. Conclusion: The COVID-19 pandemic had lowered stroke admission numbers but not stroke thrombectomy rate, successful recanalization rate, or chance of a favorable outcome. Internal delays were actually reduced during the COVID-19 pandemic. Further studies can examine the effects of COVID-19 pandemic on longer term outcome after stroke thrombectomy