Society of NeuroInterventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of COVID-19

Fraser, Justin F.; Arthur, Adam S; Chen, Michael; Levitt, Michael R.; Mocco, J; Albuquerque, Felipe C.; Ansari, Sameer A.; Dabus, Guilherme; Jayaraman, Mahesh; Mack, William J.; Milburn, James; Mokin, Maxim; Narayanan, Sandra; Puri, Ajit S; Siddiqui, Adnan H.; Tsai, Jenny P; Klucznik, Richard P.

doi:10.1136/neurintsurg-2020-016098

Cited by 93 publications

(136 citation statements)

References 9 publications

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“…5 Similarly, recent multisociety guidance agrees that intubation is not necessary for all suspected or confirmed COVID-19 patients. 11,12 The minimum possible sedation should be used in COVID-19 suspected patients, to reduce the risk that bag-mask ventilation, an aerosol-generating procedure, would be required. 11 Demand for intensive care unit (ICU) beds may exceed supply during the surge of COVID-19 patients.…”

Section: Hyperacute Stroke Carementioning

confidence: 99%

“…11,12 The minimum possible sedation should be used in COVID-19 suspected patients, to reduce the risk that bag-mask ventilation, an aerosol-generating procedure, would be required. 11 Demand for intensive care unit (ICU) beds may exceed supply during the surge of COVID-19 patients. It is appropriate to consider predicted stroke-related mortality as one of the criteria for ICU admission.…”

Section: Hyperacute Stroke Carementioning

confidence: 99%

“…Health systems in Canada face immense challenges, both to cope with the number of affected patients and the constraints imposed by containment measures such as physical distancing, quarantine, and personal protection. Stroke care across the globe and within Canada is rapidly changing to meet these challenges [1][2][3][4][5][6][7] (see Appendix 1 in Supplementary material).…”

Section: Introductionmentioning

confidence: 99%

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Canadian Stroke Best Practice Guidance During the COVID-19 Pandemic

Smith

Mountain

Hill

et al. 2020

Can. J. Neurol. Sci.

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Section: Hyperacute Stroke Carementioning

confidence: 99%

Section: Hyperacute Stroke Carementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Canadian Stroke Best Practice Guidance During the COVID-19 Pandemic

Smith

Mountain

Hill

et al. 2020

Can. J. Neurol. Sci.

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“…Additionally, SARS-CoV-2 pandemic has led to a signi cant decrease in the number of stroke cases presenting to the hospitals, prolonged time from symptoms to hospital arrival and reperfusion [7,8,13]. Furthermore, protocols have been suggested to ensure the safety of stroke team personnel during the pandemic but there is no change in the criteria for mechanical thrombectomy [14,15].…”

Section: Discussionmentioning

confidence: 99%

Mechanical Thrombectomy of Large Vessel Occlusions in COVID-19 Related Stroke: Endovascular and Clinical Outcomes

Al-Smadi

Abrol

Luqman

et al. 2020

Preprint

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Background and PurposeStroke is a drastic complication and a poor prognostic marker of COVID-19 disease which emphasizes the importance of early identification and management of this complication. In this case series, we describe our experience of mechanical thrombectomy of large vessel occlusions (LVO) in patients with COVID-19.MethodsWe performed a retrospective study of a series of confirmed COVID-19 patients who underwent endovascular thrombectomy for acute cerebrovascular ischemic disease with large vessel occlusion. Patient demographics, presentations, lab values, angiographic and clinical outcomes were also reviewed.ResultsThree COVID-19 patients with large vessel occlusion who underwent endovascular thrombectomy were identified in our multi-center institution. Two patients had respiratory symptoms prior presentation and one patient presented initially with clinical deficits. Two patients had anterior circulation occlusion in the middle cerebral artery territory vs one had posterior circulation occlusion in the basilar artery. There was good angiographic outcome post thrombectomy in all patients, however poor clinical outcomes noted with no significant improvement in neurological manifestations in comparison with baseline at presentation. All patients developed critically severe symptoms during hospitalization requiring intubation and one patient died of COVID-19 related respiratory failure.ConclusionIn this small case series, we noted worse clinical outcomes in COVID-19 related LVO stroke despite effective thrombectomy, which may be related to the underlying COVID-19 disease and/or the nature of clot in these patients.

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“…Due to the high rates of nosocomial transmission as well as the potential for overwhelming hospital resources, stroke centers across the world implemented new protocols for the triaging of patients with stroke, particularly those with LVOs requiring MT. 7 COVID-19 does not preclude patients who meet the criteria and guidelines set forth in the most recent randomized clinical trials from undergoing MT. This is a potentially lifesaving intervention that should not be withheld in eligible patients.…”

Section: Mechanical Thrombectomy (Mt) During the Covid-19 Pandemicmentioning

confidence: 99%

Incidence, Pathophysiology, and Impact of Coronavirus Disease 2019 (COVID-19) on Acute Ischemic Stroke

et al. 2020

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Society of NeuroInterventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of COVID-19

Cited by 93 publications

References 9 publications

Canadian Stroke Best Practice Guidance During the COVID-19 Pandemic

Canadian Stroke Best Practice Guidance During the COVID-19 Pandemic

Mechanical Thrombectomy of Large Vessel Occlusions in COVID-19 Related Stroke: Endovascular and Clinical Outcomes

Incidence, Pathophysiology, and Impact of Coronavirus Disease 2019 (COVID-19) on Acute Ischemic Stroke

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