Mechanical thrombectomy for acute ischaemic stroke during the COVID-19 pandemic: changes to UK practice and lessons learned (original) (raw)
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The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 2021
Introduction Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initially, COVID-19 is a disease that attacks the respiratory tract, but now the clinical manifestations of COVID-19 are various, including acute ischemic stroke (AIS). Emergency surgeries such as mechanical thrombectomy (MT) for AIS must be performed without any delay even during the COVID-19 pandemic, to reduce morbidity and mortality. Besides the focus on patient’s health, the safety of healthcare workers must also be considered. The aim of the study was to evaluate and summarize the scientific literature systematically to explore MT for AIS in the COVID-19 pandemic. Data synthesis The independent reviewers searched the literature through 12 electronic databases, searching for articles fulfilling inclusion and exclusion criteria. The data from all included studies were presented in a summary table featuring key points of each study. The authors ind...
Frontiers in Neurology, 2022
BackgroundThe coronavirus disease 2019 (COVID-19) pandemic is having a dramatic impact on acute stroke care. Its effects may accompany stroke care for a long time. We compared the treatment, short-term and long-term functional outcomes of patients with AIS from 2019 to 2020. Our objective was to evaluate the effect of COVID-19 epidemic on mechanical thrombectomy (MT) in patients in our hospital.MethodsWe collected information on subjects treated with MT in 2019–2020, including age, sex, time from the onset to arterial sheath insertion, time from the onset to recanalization, the rate of lung infection and hemorrhagic transformation, modified Rankin scale (mRS), NHISS, and ASPECTS.ResultsThe number of patients with MT decreased significantly by 26.6% in 2020 (p = 0.025). The pretreatment ASPECTS score for 2020 was significantly higher than 2019 (p = 0.004). Besides, the patients were more likely to develop lung infection (65 vs. 54.1%, p = 0.042) and had a higher risk of hemorrhagic t...
BMC Neurology
Background The novel coronavirus (COVID-19) global pandemic is associated with an increased incidence of acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO). The treatment of these patients poses unique and significant challenges to health care providers requiring changes in existing protocols. Case presentation A 54-year-old COVID-19 positive patient developed sudden onset left hemiparesis secondary to an acute right middle cerebral artery occlusion (National Institutes of Health Stroke Scale (NIHSS) score = 11). Mechanical thrombectomy (MT) was performed under a new protocol specifically designed to maximize protective measures for the team involved in the care of the patient. Mechanical Thrombectomy was performed successfully under general anesthesia resulting in TICI 3 recanalization. With regards to time metrics, time from door to reperfusion was 60 mins. The 24-h NIHSS score decreased to 2. Patient was discharged after 19 days after improvement of her pulmona...
Stroke Thrombectomy in Patients with COVID-19: Initial Experience in 13 Cases
American Journal of Neuroradiology, 2020
We performed a retrospective review in both comprehensive stroke units of a region affected early by the coronavirus disease 2019 (COVID-19) pandemic, between March 1 and April 26, 2020, including patients with COVID-19 who underwent mechanical thrombectomy for ischemic stroke. We identified 13 cases, representing 38.2% of 34 thrombectomies performed during this period. We observed increased mortality and a high incidence of thrombotic complications during hospitalization. Given the high rate of infected patients, systematic use of full personal protection measures seems justified.
Impact of COVID-19 Pandemic on a Regional Stroke Thrombectomy Service in the United Kingdom
Cerebrovascular Diseases
Introduction: We examined the impact of the coronavirus disease 2019 (COVID-19) pandemic on our regional stroke thrombectomy service in the UK. Methods: This was a single-center health service evaluation. We began testing for COVID-19 on 3 March and introduced a modified “COVID Stroke Thrombectomy Pathway” on 18 March. We analyzed the clinical, procedural and outcome data for 61 consecutive stroke thrombectomy patients between 1 January and 30 April. We compared the data for January and February (“pre-COVID,” n = 33) versus March and April (“during COVID,” n = 28). Results: Patient demographics were similar between the 2 groups (mean age 71 ± 12.8 years, 39% female). During the COVID-19 pandemic, (a) total stroke admissions fell by 17% but the thrombectomy rate was maintained at 20% of ischemic strokes; (b) successful recanalization rate was maintained at 81%; (c) early neurological outcomes (neurological improvement following thrombectomy and inpatient mortality) were not significa...
Global Impact of COVID-19 on Stroke Care and IV Thrombolysis
Neurology
ObjectiveTo measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods.MethodsWe conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.ResultsThere were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] −11.7 to −11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI −13.8 to −12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI −13.7 to −10.3, p = 0.001). Recovery...
2021
BACKGROUND The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. AIMS We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy (MT), stroke, and intracranial hemorrhage (ICH) hospitalizations over a 3-month period at the height of the pandemic (March 1 to May 31, 2020) compared with two control 3-month periods (immediately preceding and one year prior). METHODS Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. RESULTS The hospitalization volumes for any stroke, ICH, and MT were 26,699, 4,002, and 5,191 in the 3 months immediately before versus 21,576, 3,540, and 4,533 during the first 3 pandemic months, representing declines of 19.2% (95%CI,-19.7 to -18.7), 11.5% (95%CI,-12.6 to -10.6), and 12.7% ...
Stroke, 2020
an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused an international outbreak. The World Health Organization designated this as a global pandemic on March 11, 2020, with over 200 countries affected worldwide. As of April 24, 2020, there were 2 790 986 patients with confirmed COVID-19 and 195 775 deaths worldwide, with the United States, Spain, Italy, France, Germany, United Kingdom, Turkey, and Iran surpassing China in the number of confirmed cases. 1 In a consecutive series of 221 patients with confirmed COVID-19 admitted to a hospital in Wuhan, China, acute ischemic stroke occurred in 11(5%) of patients with a broad range of stroke subtypes. 2 These patients with stroke were older, more likely to have cardiovascular risk factors, presenting with severe COVID-19 with multiple organ involvement. Of note, presence of COVID-19 in these patients does not imply that COVID-19 was the mechanism leading to the patient's stroke. Shortages of Personal Protective Equipment (PPE) such as N95 masks, facial shields, hand sanitizer, and cleansing wipes have presented a major challenge in the allocation of resources, as healthcare workers are frontline in the treatment
Initial Stroke Thrombectomy Experience in New York City during the COVID-19 Pandemic
American Journal of Neuroradiology
New York City has become the global epicenter of the coronavirus 2019 (COVID-19) pandemic. Despite a massive shift in health care resources, cerebrovascular disease continues to be a substantial burden. We review the first 10 patients undergoing thrombectomy following a series of governmental and institutional policy changes diverting resources to the care of critically ill patients with COVID-19. Ten patients with emergent large-vessel occlusion underwent thrombectomy between March 23 and April 1, 2020. Five patients tested positive for the COVID-19 virus. Successful reperfusion was achieved in 9 of 10 patients, at a median time of 37 minutes from vascular access. The postprocedural NIHSS score improved by an average of 7.7 points. Of the 5 patients positive for COVID-19, none have experienced a critical respiratory illness. We report the early incidence of COVID-19 positivity in patients with emergent large-vessel occlusion and demonstrate that thrombectomy continues to be an efficacious option, as well as safe for health care providers.