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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Maintaining the Quality of Mechanical Thrombectomy after Acute Ischemic Stroke in COVID(-)19 Patients
Yu-Hao Chang1, Nien-Chen Liao1,2,3, Yuang-Seng Tsuei1,4,5,6
1Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
Insights
Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) with large-vessel occlusion (LVO) in COVID-19 negative patients showed no significant time delays during the pandemic. Established protocols ensured timely treatment without compromising patient care or healthcare worker safety.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Infectious Diseases
Background:
- The COVID-19 pandemic posed challenges to healthcare systems, potentially impacting time-sensitive treatments like mechanical thrombectomy (MT).
- Maintaining effective treatment standards for acute ischemic stroke (AIS) with large-vessel occlusion (LVO) during the pandemic was a significant concern.
- Ensuring the safety of healthcare personnel while managing stroke patients required robust protocols.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on the timeliness of mechanical thrombectomy (MT) for COVID-19 negative patients with acute ischemic stroke (AIS) and large-vessel occlusion (LVO).
- To compare treatment times between pre-pandemic and during-pandemic periods.
- To assess the effectiveness of established protocols in maintaining treatment standards.
Main Methods:
- Retrospective, single-center study.
- Inclusion of COVID-19 negative patients with AIS and LVO undergoing MT.
- Comparison of two groups: pre-COVID-19 (December 2020 - May 2021) and during COVID-19 (June 2021 - November 2021).
- Analysis of door-to-computed-tomography-angiography (CTA) and door-to-groin-puncture times.
Main Results:
- No significant median time difference was observed in door-to-CTA (19.0 min vs. 20.0 min, p = 0.398) between pre-pandemic and during-pandemic groups.
- No significant median time difference was observed in door-to-groin-puncture (118.0 min vs. 109.0 min, p = 0.281) between the two groups.
- Rapid PCR testing during triage did not cause delays in MT or compromise safety protocols.
Conclusions:
- Established healthcare protocols effectively managed COVID-19 negative patients with AIS and LVO undergoing mechanical thrombectomy during the pandemic.
- Timeliness of MT treatment was maintained, with no significant delays compared to the pre-pandemic period.
- The study demonstrates the feasibility of continuing critical stroke interventions safely amidst a pandemic.
Abstract:
The COVID-19 pandemic has become increasingly worse worldwide since it was discovered in China in late December 2019. Easy contact transmission between people and a low to moderate mortality rate may cause failure in medical health services if there is no proper personal protective equipment for personnel. During the pandemic, patients with acute ischemic stroke with large-vessel occlusion who required immediate treatment through mechanical thrombectomy (MT) were still being sent to the emergency room. Knowing how to maintain effective treatment standards has become our concern. We used a retrospective, single-center study to select COVID-19 (-) patients with acute ischemic stroke undergoing mechanical thrombectomy during the years 2020-2021. Patients with acute ischemic stroke with large-vessel occlusion received mechanical thrombectomy were compared with patients admitted from December 2020 to May 2021 (the pre-COVID-19 group) and those from June 2021 to November 2021 (the during COVID-19 group). Furthermore, the time disparity of mechanical thrombectomy was compared between these two groups. Of patients confirmed with acute ischemic stroke (AIS) with large-vessel occlusion (LVO) during the study period, 62 were included. Compared with the pre-COVID-19 group (34 patients; median age, 70.5 years), the during COVID-19 group (28 patients; median age, 71.5 years) showed no major median time difference in door-to-computed-tomography-angiography (CTA) time (19.0 min vs. 20.0 min, p = 0.398) and no major median time difference in door-to-groin-puncture time (118.0 min vs. 109.0 min, p = 0.281). In our study, with a prepared protocol for the pandemic having been established in the healthcare system, we could see no difference between the pre-pandemic and during-pandemic time periods when using mechanical thrombectomy to treat COVID-19 (-) patients of AIS with LVO. By means of a quick-PCR test during triage, there was no time delay to perform MT or any lowering of safety protocol for workers in the healthcare system.
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