Interventional Stroke Care in the Era of COVID-19

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• The COVID-19 pandemic has strained healthcare systems globally.
• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to neurological complications, including ischemic stroke.
• Ischemic stroke in COVID-19 patients may arise from viral complications, pre-existing conditions, or common stroke risk factors.

Purpose of the Study:

• To outline considerations for mechanical thrombectomy (MT) in acute ischemic stroke patients with large vessel occlusions (LVO) during the COVID-19 pandemic.
• To identify key prognostic factors for MT selection in this patient population.
• To provide guidance for managing LVO patients with suspected or confirmed COVID-19.

Main Methods:

• Review of prognostic factors relevant to MT in COVID-19 patients.
• Discussion of resource utilization and infection risk for healthcare workers.
• Presentation of an illustrative case study.

Main Results:

• Mechanical thrombectomy for LVO in COVID-19 patients requires careful consideration of disease severity, resource allocation, and healthcare worker safety.
• Prognostic factors such as age, laboratory results, and imaging findings are crucial for MT eligibility assessment.
• A conservative approach may be warranted in cases of clinical equipoise to minimize futile interventions.

Conclusions:

• Mechanical thrombectomy should be performed within established guidelines for acute ischemic stroke with LVO, even during the COVID-19 pandemic.
• A nuanced approach balancing potential benefits against risks is essential for decision-making.
• Careful patient selection and management are critical to optimize outcomes and ensure healthcare worker safety.