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. 2022 May;75(5):1670-1678.e2.
doi: 10.1016/j.jvs.2021.11.064. Epub 2021 Dec 15.

Impact of the first COVID-19 pandemic peak and lockdown on the interventional management of carotid artery stenosis in France

Valentin Crespy  1 , Eric Benzenine  2 , Anne-Sophie Mariet  3 , Anna Baudry  1 , Chloe Bernard  1 , Yannick Bejot  4 , Maurice Giroud  4 , Eric Steinmetz  1 , Catherine Quantin  5
Affiliations

Impact of the first COVID-19 pandemic peak and lockdown on the interventional management of carotid artery stenosis in France

Valentin Crespy et al. J Vasc Surg. 2022 May.

Abstract

Objective: The aim of this study was to evaluate the impact of the COVID-19 pandemic on the trends of carotid revascularization (endarterectomy [CEA], transfemoral carotid artery stenting [TFCAS]) for symptomatic and asymptomatic carotid stenosis before, during, and after the end of the first lockdown in 2020 in France.

Methods: Nationwide data were provided by the French National Hospital Discharge database (Programme de Médicalisation des Systèmes d'Information). We retrospectively analyzed patients admitted for CEA or TFCAS in all French public and private hospitals during a 9-month period (January-September) in 2017, 2018, 2019, and 2020. Procedures were identified using the French Common Classification of Medical Procedures. Stenoses were considered symptomatic in the presence of stroke and/or transient ischemic attack codes (according to the International Classification of Diseases-Tenth Revision) during the stay, and asymptomatic in the absence of these codes. Hospitalization rates in 2020 were compared with the rates in the same period in the 3 previous years.

Results: Between January and September 2020, 12,546 patients were hospitalized for carotid artery surgery (CEA and TFCAS) in France. Compared with the 3 previous years, there was a decrease in hospitalization rates for asymptomatic (-68.9%) and symptomatic (-12.6%) CEA procedures in April, starting at the pandemic peak concomitant with the first national lockdown. This decrease was significant for asymptomatic CEA (P < .001). After the lockdown, while CEA for asymptomatic stenosis returned to usual activity, CEA for symptomatic stenosis presented a significant rebound, up 18.52% in August compared with previous years. Lockdown also had consequences on TFCAS procedures, with fewer interventions for both asymptomatic (-60.53%) and symptomatic stenosis (-16.67%) in April.

Conclusions: This study demonstrates a severe decrease for all interventions during the first peak of the COVID-19 pandemic in France. However, the trends in the postlockdown period were different for the various procedures. These data can be used to anticipate future decisions and organization for cardiovascular care.

Keywords: Carotid artery stenosis; Carotid artery stenting; Carotid endarterectomy; Coronavirus disease 2019; Lockdown; Pandemic peak.

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Figures

Fig 1
Fig 1
All carotid revascularization interventions in France in 2020 and in 2017-2019, and pandemic peak/number of hospitalizations.
Fig 2
Fig 2
Monthly comparison of hospitalizations for carotid endarterectomy in 2020 compared with January to September 2017-2019. A, Carotid endarterectomy (CEA). B, CEA for symptomatic stenoses. C, CEA for asymptomatic stenoses.
Fig 3
Fig 3
Monthly comparison of hospitalizations for carotid artery stenting in 2020 compared with January to September 2017-2019. A, Carotid artery stenting (CAS). B, CAS for symptomatic stenoses. C, CAS for asymptomatic stenoses.
Supplementary Fig (online only)
Supplementary Fig (online only)
Observed (Obs) and predicted (ITS) hospitalizations for carotid revascularization intervention for weeks 2 to 39 of 2020 in France, interrupted time series (ITS) analysis with three periods (before, during, after the first lockdown).
See this image and copyright information in PMC

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