The Impact of the Pandemic on Acute Ischaemic Stroke Endovascular Treatment from a Multidisciplinary Perspective: A Nonsystematic Review

Abstract

Background: At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reduced admissions for cerebrovascular events were identified, but acute ischaemic stroke (AIS) has remained one of the leading causes of death and disability for many years. The aim of this article is to review current literature data for multidisciplinary team (MDT) coordination, rational management of resources and facilities, ensuring timely medical care for large vessel occlusion (LVO) AIS patients requiring endovascular treatment during the pandemic. Methods: A detailed literature search was performed in Google Scholar and PubMed databases using these keywords and their combinations: acute ischaemic stroke, emergency, anaesthesia, airway management, mechanical thrombectomy, endovascular treatment, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19. Published studies and guidelines from inception to April 2021 were screened. The following nonsystematic review is based on a comprehensive literature search of available data, wherein 59 were chosen for detailed analysis. Results: The pandemic has an impact on every aspect of AIS care, including prethrombectomy, intraprocedural and post-thrombectomy issues. Main challenges include institutional preparedness, increased number of AIS patients with multiorgan involvement, different work coordination principles and considerations about preferred anaesthetic technique. Care of these patients is led by MDT and nonoperating room anaesthesia (NORA) principles are applied. Conclusions: Adequate management of AIS patients requiring mechanical thrombectomy during the pandemic is of paramount importance to maximise the benefit of the endovascular procedure. MDT work and familiarity with NORA principles decrease the negative impact of the disease on the clinical outcomes for AIS patients.

Application Analysis of Multidisciplinary Diagnosis and Treatment Nursing Mode Based on Doctor-Nurse-Integration for Stroke Patients Undergoing Emergency Intervention Surgery

“…Te advantage of stent thrombectomy technology is that it can provide a longer treatment time window and a higher recovery rate, thus improving the clinical outcome of AIS patients [17]. In this result, the postoperative disability rate of the MDT group is lower than that of the TMC group (P < 0.05), suggesting that the application of the MDT nursing mode based on doctor-nurse-integration can improve the clinical outcome of AIS patients and reduce the postoperative disability rate, which is consistent with the study of Grigonyte [18]. Tis is mainly because the collaborative response ability of the multidisciplinary team in the MDT group can efectively shorten the treatment time window, which is very important.…”

Tatalaksana Oklusi Pembuluh Darah Besar Pada Pasien Stroke Iskemik Akut Dengan Infeksi Covid-19 : Sebuah Review Narasi

“…Sejak pandemi global coronavirus disease 2019 (Covid-19) dinyatakan oleh WHO pada 11 Maret 2020, stroke iskemik akut tetap menjadi salah satu penyebab utama kematian dan kecacatan jangka panjang. 1 Keadaan hiperkoagulasi yang disebabkan oleh sindrom pernapasan akut berat karena infeksi coronavirus 2 (SARSCoV-2) menyebabkan peningkatan frekuensi terjadinya gangguan tromboemboli yang memicu terjadinya stroke iskemik akut karena oklusi pembuluh darah besar (AIS LVO). Stroke iskemik akut akibat oklusi pembuluh darah besar pada pasien Covid-19 dapat terjadi pada usia muda tanpa adanya faktor resiko/komorbid vaskular sebelumnya dengan angka kematian sebesar 44,2 % -60%.…”

“…Pilihan terapi di atas disesuaikan dengan onset kejadian AIS, derajat keparahan infeksi covid-19 dan ketersediaan sarana serta tim multidisiplin. 1,2,4,5,6,8,9 Trombektomi mekanis adalah metode pengobatan invasif untuk AIS LVO yang menggunakan balon kateter yang dimasukkan ke dalam sistem arteri sehingga diperlukan Angiogram CT sebelum dilakukan pemindahan pasien ke pusat trombektomi untuk memastikan keberadaan LVO. 1 Tabel 1.…”

“…1,2,4,5,6,8,9 Trombektomi mekanis adalah metode pengobatan invasif untuk AIS LVO yang menggunakan balon kateter yang dimasukkan ke dalam sistem arteri sehingga diperlukan Angiogram CT sebelum dilakukan pemindahan pasien ke pusat trombektomi untuk memastikan keberadaan LVO. 1 Tabel 1. Indikasi dan kontraindikasi trombektomi mekanis 1 Indikasi Kontraindikasi Waktu dari timbulnya gejala hingga sebelum tindakan trombektomi ≤6 jam Trombositopenia < 30 x 10 Keberhasilan tindakan trombektomi mekanis dinilai dengan melakukan pemeriksaan CT angiogram, yang kemudian dilakukan penilaian hasil angiografi menggunakan thrombolysis in cerebral infarction (TICI) scores, dengan range skor dari 0-3, skor 3 menunjukan perfusi lengkap.…”

“…1 Tabel 1. Indikasi dan kontraindikasi trombektomi mekanis 1 Indikasi Kontraindikasi Waktu dari timbulnya gejala hingga sebelum tindakan trombektomi ≤6 jam Trombositopenia < 30 x 10 Keberhasilan tindakan trombektomi mekanis dinilai dengan melakukan pemeriksaan CT angiogram, yang kemudian dilakukan penilaian hasil angiografi menggunakan thrombolysis in cerebral infarction (TICI) scores, dengan range skor dari 0-3, skor 3 menunjukan perfusi lengkap. 2 Tabel 2.…”