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Published on: January 18, 2018
Preserving Access: A Review of Stroke Thrombectomy during the COVID-19 Pandemic
T M Leslie-Mazwi1,2, K M Fargen3, M Levitt4
1From the Departments of Neurology (T.M.L.-M.) tleslie-mazwi@mgh.harvard.edu.
Insights
The COVID-19 pandemic significantly impacts emergency care for large-vessel occlusion stroke patients. Maintaining access to thrombectomy is crucial for public health, requiring adaptable stroke systems of care.
Area of Science:
- Neurology
- Public Health
- Infectious Diseases
Background:
- The COVID-19 pandemic has disrupted healthcare systems globally.
- Large-vessel occlusion stroke requires timely mechanical thrombectomy for effective treatment.
- Pandemic conditions pose unique challenges to stroke care delivery.
Purpose of the Study:
- To review the implications of COVID-19 on emergency care for large-vessel occlusion stroke.
- To provide recommendations for adapting stroke systems of care during pandemics.
- To emphasize the importance of preserving access to thrombectomy.
Main Methods:
- Review of current literature and expert consensus on stroke care during pandemics.
- Analysis of infection-control measures relevant to thrombectomy procedures.
- Examination of adaptations in imaging, thrombectomy, and postprocedural care.
Main Results:
- COVID-19 necessitates specific infection-control protocols for stroke patients.
- Adaptations in stroke systems of care are essential to maintain treatment access.
- Tiered planning for escalating and de-escalating measures is recommended.
Conclusions:
- Preserving access to mechanical thrombectomy for large-vessel occlusion stroke is a public health priority during pandemics.
- Stroke systems must implement flexible strategies to manage pandemic-related challenges.
- Preparedness for future pandemics through adaptable care models is vital.
Abstract:
Thrombectomy for large-vessel-occlusion stroke is a highly impactful treatment. The spread of coronavirus 19 (COVID-19) across the United States and the globe impacts access to this crucial intervention through widespread societal and institutional changes. In this document, we review the implications of COVID-19 on the emergency care of large-vessel occlusion stroke, reviewing specific infection-control recommendations, available literature, existing resources, and expert consensus. As a population, patients with large-vessel occlusion stroke face unique challenges during pandemics. These are broad in scope. Responses to these challenges through adaptation of stroke systems of care and with imaging, thrombectomy, and postprocedural care are detailed. Preservation of access to thrombectomy must be prioritized for its public health impact. While the extent of required changes will vary by region, tiered planning for both escalation and de-escalation of measures must be a part of each practice. In addition, preparations described serve as templates in the event of future pandemics.
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