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The Society of Vascular and Interventional Neurology recommends a modified algorithm for mechanical thrombectomy in acute ischemic large-vessel occlusion stroke in the era of the COVID-19 pandemic. They divide their recommendations into four phases: prehospital phase to the emergency department (ED), pre-thrombectomy procedure, thrombectomy intra-procedure, and post-reperfusion therapy. The goal of these guidelines is focused on protecting healthcare providers while simultaneously providing optimal care, patient safety, and access for patients with stroke. The guidelines specifically add considerations for patients with a positive screen for COVID-19, focusing on how to incorporate telecommunication, use of personal protective equipment, the timing of CT/CTA, airway and thrombectomy room preparation, as well as guidelines on neurological examination during post-thrombectomy and post-acute care.
These are detailed and specific recommendations that can be very useful during a time-sensitive multidisciplinary team effort during this COVID-19 pandemic.
– Omar Iqbal Khan, MD
This abstract is available on the publisher's site.
In December 2019, coronavirus disease 2019 (COVID-19), 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.
Mechanical Thrombectomy in the Era of the COVID-19 Pandemic: Emergency Preparedness for Neuroscience Teams: A Guidance Statement From the Society of Vascular and Interventional Neurology
Stroke 2020 Jun 01;51(6)1896-1901, TN Nguyen, M Abdalkader, TG Jovin, RG Nogueira, AP Jadhav, DC Haussen, AE Hassan, R Novakovic, SA Sheth, S Ortega-Gutierrez, PD Panagos, SM Cordina, I Linfante, OY Mansour, AM Malik, S Narayanan, HE Masoud, SH Chou, R Khatri, V Janardhan, DR Yavagal, OO Zaidat, DM Greer, DS Liebeskind