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Updated: Aug 20, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Large-Vessel Occlusion Stroke Treated by Endovascular Thrombectomy in Patient with Coronavirus Disease 2019
Yuko Tsurumi1, Noriaki Matsubara2, Hayato Yokoyama1
1Department of Neurosurgery, Tsurumi Hospital, Koga, Ibaraki, Japan.
Insights
This case study shows successful endovascular thrombectomy for acute ischemic stroke in a COVID-19 patient. Neuroendovascular procedures can be safely performed during the pandemic with proper infection control.
Area of Science:
- Neurology
- Infectious Diseases
- Interventional Radiology
Background:
- Coronavirus disease 2019 (COVID-19) is associated with an increased risk of cerebrovascular events, including ischemic stroke.
- Large-vessel occlusion (LVO) stroke in COVID-19 patients presents unique management challenges due to potential infectivity and procedural risks.
Observation:
- A 41-year-old male with moderately severe COVID-19 developed acute ischemic stroke with left middle cerebral artery occlusion 14 days post-onset.
- The patient presented with neurological deficits including dysarthria and right hemiplegia.
Findings:
- Successful endovascular thrombectomy using a stent retriever was performed under local anesthesia and sedation.
- The procedure achieved recanalization within 30 minutes with minimal staff exposure and strict infection control measures.
- No secondary infections were observed in the medical staff or other patients.
Implications:
- This case demonstrates the feasibility and safety of performing emergent neuroendovascular interventions in COVID-19 patients.
- Appropriate personal protective equipment and procedural modifications can mitigate transmission risks during endovascular procedures.
- Timely mechanical thrombectomy remains a critical treatment for LVO stroke, even in the context of infectious diseases like COVID-19.
Abstract:
We report a case of acute ischemic stroke caused by large-vessel occlusion in a patient infected with coronavirus disease 2019 (COVID-19) who was treated by endovascular thrombectomy. The patient was a 41-year-old man hospitalized with moderately severe COVID-19. Fourteen days after the onset of COVID-19, dysarthria and right hemiplegia were observed, and acute occlusion of the left middle cerebral artery was diagnosed. Mechanical thrombectomy was performed with a stent retriever while the patient was under local anesthesia and sedation. The staff involved in the intervention was as minimal as possible. The interventional surgeon wore a disposable surgical gown, an N95 mask, a face shield, and two pairs of gloves, while the patient was fitted with a surgical mask. The intervention involved the usual procedures, such as sheath insertion, catheter manipulation, and stent deployment, and the thrombus was removed with the stent retriever. The time from puncture to recanalization was within 30 minutes. No infection was observed in our staff or inpatients after the intervention. Thus, we were able to perform neuroendovascular treatment without spreading COVID-19 by taking appropriate measures to prevent infection.
