MENA-SINO Consensus Statement on Implementing Care Pathways for Acute Neurovascular Emergencies During the COVID-19 Pandemic

Abstract

In the unprecedented current era of the COVID-19 pandemic, challenges have arisen in the management and interventional care of patients with acute stroke and large vessel occlusion, aneurysmal subarachnoid hemorrhage, and ruptured vascular malformations. There are several challenges facing endovascular therapy for stroke, including shortages of medical staff who may be deployed for COVID-19 coverage or who may have contracted the infection and are thus quarantined, patients avoiding early medical care, a lack of personal protective equipment, delays in door-to-puncture time, anesthesia challenges, and a lack of high-intensity intensive care unit and stroke ward beds. As a leading regional neurovascular organization, the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO) has established a task force composed of medical staff and physicians from different disciplines to establish guiding recommendations for the implementation of acute care pathways for various neurovascular emergencies during the current COVID-19 pandemic. This consensus recommendation was achieved through a series of meetings to finalize the recommendation.

Severe Acute Respiratory Syndrome Coronavirus 2-Induced Neurological Complications

“…Other the other hand, the management and treatment of acute or chronic primary neurological diseases cannot be neglected (von Oertzen et al, 2020 ). Task forces comprised of medical staff have been placed to guarantee emergency care of acute neurovascular events (Al-Jehani et al, 2020 ). Clinicians can observe their patients with preexisting seizure disorders through regular telemedicine (Parihar et al, 2020 ).…”

Scoping Review of Existing Stroke Guidelines; Argument for a Value-Added Change

“…A unified approach is also being implemented in Australia and New Zealand as they both adapt the Australian Clinical Guideline for Stroke Management published in 2017 (27). More recently, the Middle East and North Africa Stroke and Interventional Neurotherapies Organization has also created a consolidated plan to manage stroke in the midst of the pandemic (28).…”

Lessons learned in stroke care during COVID-19 pandemic and preparing for future pandemics in the MENA+ region: A consensus statement from the MENA+-SINO

“…The treatment of stroke requires immediate evaluation, imaging, and initiation of reperfusion therapies. Stroke services were not immune from this pandemic with multiple reports of delay in hospital admissions and delay to treatment that may have resulted in poor outcome [ [5] , [6] , [7] , [8] , [9] , [10] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ]. Several stroke organizations and stroke specialists around the world have raised red flags [ [5] , [6] , [7] , [8] , [9] , [10] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ].…”

“…Stroke services were not immune from this pandemic with multiple reports of delay in hospital admissions and delay to treatment that may have resulted in poor outcome [ [5] , [6] , [7] , [8] , [9] , [10] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ]. Several stroke organizations and stroke specialists around the world have raised red flags [ [5] , [6] , [7] , [8] , [9] , [10] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ]. Numerous research papers from around the world have discussed the most important challenges the world has faced in treating stroke patients in these difficult times and few provided recommendations and pathways for better management of stroke patients during this pandemic.…”

“…The emergence of new variants of COVID-19 [ 3 , 4 ], with potential for increased spread in the community and higher virulence, pose serious demand on health systems globally in the coming years [ 1 ]. Since the start of COVID-19 pandemic major complications on the care of a number of disorders including stroke have been witness [ [5] , [6] , [7] , [8] , [9] , [10] ]. COVID-19 also resulted in major vascular neurological complications.…”