An International Report on the Adaptations of Rapid Transient Ischaemic Attack Pathways During the COVID-19 Pandemic

Abstract

Background This report aims to describe changes that centres providing transient ischaemic attack (TIA) pathway services have made to stay operational in response to the SARS-CoV-2 pandemic . Methods An international cross-sectional description of the adaptions of TIA pathways between 30 th March and 6 th May 2020. Experience was reported from 18 centres with rapid TIA pathways in seven countries (Australia, France, UK, Canada, USA, New Zealand, Italy, Canada) from three continents. Results All pathways remained active (n = 18). Sixteen (89%) had TIA clinics. Six of these clinics (38%) continued to provide in-person assessment while the majority (63%) used telehealth exclusively. Of these, three reported PPE use and three did not. Five centres with clinics (31%) had adopted a different vascular imaging strategy. Conclusion The COVID pandemic has led TIA clinics around the world to adapt and move to the use of telemedicine for outpatient clinic review and modified investigation pathways. Despite the pandemic, all have remained operational.

Rapid outpatient transient ischemic attack clinic and stroke service activity during the SARS-CoV-2 pandemic: a multicenter time series analysis

“…The initial paper identified 16 clinics via a literature review of rapid TIA pathways in PubMed ( 9 ). Six of these centers agreed to provide 3 years of data.…”

“…All accepted TIA referrals; Oxfordshire ( 2 ) also accepted minor stroke in addition to TIA. Monash Medical Center and John Radcliffe reported using ultrasound for vascular imaging pre-COVID ( 9 ) with the rest using CT angiography. All centers were utilizing CT angiography for vessel imaging during the COVID period ( 9 ).…”

“…Monash Medical Center and John Radcliffe reported using ultrasound for vascular imaging pre-COVID ( 9 ) with the rest using CT angiography. All centers were utilizing CT angiography for vessel imaging during the COVID period ( 9 ). While each service used their own unique inclusion and exclusion criteria for the rapid TIA pathway, two went further by prioritizing time to review by mechanism (i.e., the presence of atrial fibrillation and/or >50% internal carotid artery stenosis) ( 1 ) or by timing of symptom onset and presence of other high-risk features (e.g., motor/speech deficit >5 min, ABCD2 ≥ 4, or atrial fibrillation) ( 12 ).…”

“… *As at 2020 ( 9 ). ED, emergency department; TIA, transient ischemic attack; US, ultrasound; CTA, computed tomography angiography; OXVASC, Oxford Vascular Study; NIHSS, National Institutes of Health Stroke Scale.…”

“…TIA presentations, ischemic stroke presentations, and trends in reperfusion therapies including IV thrombolysis (IVT) and endovascular thrombectomy (EVT) are analyzed. The study provides follow-up data to a recent paper of 16 rapid TIA clinics that documented various pandemic adaptations: five had adopted a different vascular imaging strategy, 10 had switched to exclusive telehealth consultation, and all remained active ( 9 ). Six of these 16 hospitals agreed to submit 3 years of data, and the results are shared here.…”