O-052 - EVALUATION OF COVID-19'S IMPACT ON SYMPTOMATIC CAROTID ARTERY PROCEDURES IN SWEDEN

TOPIC:
Peripheral Arterial Aneurysms
AUTHORS:
Sinabulya H. (Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ~ Stockholm ~ Sweden) , Wahlgren C.M. (Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ~ Stockholm ~ Sweden) , Jonsson M. (Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ~ Stockholm ~ Sweden) , Hultgren R. (Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ~ Stockholm ~ Sweden)
Introduction:
The coronavirus Sars-Cov-2 (Covid-19) started to spread in Sweden in March 2020 and on the 11th of that month the World Health Organization declared Covid-19 a global pandemic (1). The Covid-19 pandemic has been reported to have rendered a decrease in the rate of hospital admissions for medical emergencies such as stroke(2, 3). Carotid stenosis is considered to be responsible for 10% to 15% of ischemic strokes. These strokes may be prevented by carotid endarterectomy (CEA) or transfemoral carotid artery stenting (TFCAS). In current guidelines, CEA for symptomatic stenosis must be performed within 14 days after symptom onset to decrease the risk of recurrent strokes and transient ischemic attacks (TIA), for which the risk in this period is up to 25%. There has been varying strategies globally regarding restrictions such as lockdowns which has also affected healthcare provision. Sweden didn't have any lockdown and the impact, of an alternative strategy, on the management of peripheral vascular disease such as carotid stenosis therefore needs to be assessed.
Methods:
All symptomatic patients surgically treated for carotid stenosis between January 2015 and December 2021 were included. Stenoses were considered symptomatic in the presence of stroke and/or TIA. The data comprised of a retrospective cohort from the Swedish National Registry for Vascular Surgery (Swedvasc). Analysis was done to compare overall volumes as well as the median time from qualifying event to surgery. The years 2015-2019 (pre-pandemic) were compared with 2020 and 2021 (per-pandemic).
Results:
The mean registered volumes for carotid surgery between 2015 and 2019 was 799 (95% CI 797.9 - 800.1) procedures and was similar in 2020 with 758 procedures but increased in 2021 to 853 procedures. Monthly comparison for the different years is shown in figure 1. Pre-pandemic a steady number of procedures was carried out over the year, which was the case for 2020 but in 2021 January and February had a significantly higher number of procedures, 102 and 116 respectively. The median number of days from time for qualifying event to surgery is shown in figure 2. Pre-pandemic compared to 2020 and 2021 had an unchanged median of 7 days. About 17% of all patients were reported to have suffered a new event during their wait for surgery from the qualifying event, see table 1.
Conclusion:
Sweden's response to the pandemic showed no significant change in overall volume of treated patients with symptomatic carotid stenoses. The median number of days to treatment from qualifying event was unchanged. We could not see a change in the proportion of patients presenting with a new event while waiting for surgery.
References:
1. Coronavirus disease 2019 (‎COVID-19)‎: situation report, 51. iris; 2020. 2. Mariet AS, Giroud M, Benzenine E, Cottenet J, Roussot A, Aho-Glele LS, et al. Hospitalizations for Stroke in France During the COVID-19 Pandemic Before, During, and After the National Lockdown. Stroke. 2021;52(4):1362-9. 3. Nogueira RG, Abdalkader M, Qureshi MM, Frankel MR, Mansour OY, Yamagami H, et al. Global impact of COVID-19 on stroke care. Int J Stroke. 2021;16(5):573-84.
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