Stroke Care during the COVID-19 Pandemic: International Expert Panel Review.

Area of Science:

• Neurology
• Infectious Diseases
• Public Health

Background:

• Coronavirus disease 2019 (COVID-19) has significantly impacted healthcare systems globally.
• Stroke is a recognized complication of COVID-19, presenting complex etiological challenges.
• International stroke experts convened to address the growing body of evidence and clinical experience with COVID-19-related stroke.

Purpose of the Study:

• To assess current research and clinical experience regarding stroke in COVID-19 patients.
• To provide evidence-based recommendations for comprehensive stroke management during the pandemic.
• To guide modifications in stroke care across prehospital, inpatient, rehabilitation, and follow-up settings.

Main Methods:

• Review of rapidly growing international research on COVID-19 and stroke.
• Consensus-building among a large panel of stroke experts.
• Analysis of personal clinical experiences with COVID-19 stroke cases.
• Development of recommendations for various stages of stroke care.

Main Results:

• COVID-19 presents unique stroke etiologies including vasculitis, hypercoagulable states, and endothelial dysfunction.
• Standard acute stroke management (thrombolysis, thrombectomy, hypertension control) should continue, with considerations for ACE inhibitors/ARBs and anticoagulation.
• Strict infection control measures are paramount for patient and staff safety throughout the care continuum.
• Telemedicine is increasingly utilized for post-discharge care and patient-physician contact.

Conclusions:

• Evidence-based stroke management must be maintained alongside rigorous infection control protocols.
• Adaptations in stroke care are necessary to accommodate the complexities of COVID-19.
• Multispecialty collaboration and evolving treatment strategies are crucial for optimal outcomes in COVID-19 stroke patients.