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Effects of an Infection Control Protocol for Coronavirus Disease in Emergency Mechanical Thrombectomy

Jin Eun1, Min-Hyung Lee1, Sang-Hyuk Im1

  • 1Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Journal of Korean Neurosurgical Society
|December 9, 2021
PubMed

Insights

The COVID-19 protection protocol increased door-to-imaging time for stroke thrombectomy. Optimizing imaging and anesthesia can reduce procedure delays, improving patient outcomes during pandemics.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Public Health

Background:

  • The COVID-19 pandemic raised concerns about infection prevention and procedural delays in emergency mechanical thrombectomy for acute stroke.
  • Neurointerventionists faced challenges adapting protocols to balance patient safety and timely treatment during the pandemic.

Purpose of the Study:

  • To analyze the impact of modified mechanical thrombectomy protocols during the COVID-19 pandemic on procedure times and patient outcomes.
  • To identify key factors influencing procedure delays in acute stroke thrombectomy.

Main Methods:

  • Retrospective analysis of 88 patients undergoing mechanical thrombectomy, comparing pre-COVID-19 conventional protocols (n=45) with COVID-19 protection protocols (n=43).
  • Evaluation of key time metrics: last-normal-to-door, first-abnormal-to-door, door-to-imaging, door-to-puncture, and puncture-to-recanalization.
  • Multivariate analysis to identify significant predictors of door-to-puncture and total procedure times.

Main Results:

  • The COVID-19 protection protocol significantly increased door-to-imaging time (p=0.0257), particularly in suspected COVID-19 cases.
  • No significant difference in door-to-puncture time was observed between protocols (p=0.5042).
  • Multivariate analysis revealed last-normal-to-door and door-to-imaging times as significant factors affecting door-to-puncture time. Total procedure time was influenced by occlusion site, last-normal-to-door time, door-to-imaging time, and anesthesia type.

Conclusions:

  • The COVID-19 protection protocol notably impacted door-to-imaging time.
  • Reducing door-to-imaging time and utilizing local anesthesia where feasible are crucial for shortening door-to-puncture and recanalization times.
  • Further research is needed to fully understand the multifaceted effects of pandemic-related protection protocols on emergency thrombectomy.
Abstract

Keywords:
COVID-19Stroke, acuteThrombectomy

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