Mechanical Thrombectomy of COVID-19 positive acute ischemic stroke patient: a case report and call for preparedness

Abstract

Background The novel coronavirus (COVID-19) global pandemic is associated with an increased incidence of acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO). The treatment of these patients poses unique and significant challenges to health care providers requiring changes in existing protocols. Case presentation A 54-year-old COVID-19 positive patient developed sudden onset left hemiparesis secondary to an acute right middle cerebral artery occlusion (National Institutes of Health Stroke Scale (NIHSS) score = 11). Mechanical thrombectomy (MT) was performed under a new protocol specifically designed to maximize protective measures for the team involved in the care of the patient. Mechanical Thrombectomy was performed successfully under general anesthesia resulting in TICI 3 recanalization. With regards to time metrics, time from door to reperfusion was 60 mins. The 24-h NIHSS score decreased to 2. Patient was discharged after 19 days after improvement of her pulmonary status with modified Rankin Scale = 1. Conclusion Patients infected by COVID-19 can develop LVO that is multifactorial in etiology. Mechanical thrombectomy in a COVID-19 confirmed patient presenting with AIS due to LVO is feasible with current mechanical thrombectomy devices. A change in stroke workflow and protocols is now necessary in order to deliver the appropriate life-saving therapy for COVID-19 positive patients while protecting medical providers.

Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in COVID-19 pandemic: a systematic review

“… Kwan J, UK [ 49 ] Good Good Fair Fair Good Good Good Good Good 7. Mansour OY, Egypt [ 50 ] Good Fair Fair Fair Good Fair Good Good Good 8. McConachie D, UK [ 51 ] Good Good Good Good Good Good Good Good Good 9.…”

“… 7. Mansour OY, Egypt [ 50 ] Case report 1 Patient outcome, PCS in MT of AIS patients The NIHSS score decreased to 2 after reperfusion (from 14 before MT). The importance of PCS implementation and the use of PPE during MT.…”

“…PCS is the modified of regular code stroke during the COVID-19 pandemic to provide an additional layer of protection (including PPE) for patients and medical personnel who were engaged in triage, rapid assessment, COVID-19 screening, and treatment of patients [ 30 ]. Cox and colleagues (2020), Mansour and colleagues (2020), Yaeger and colleagues (2020), and Yeboah and colleagues (2020) and reported about the importance of healthcare worker to follow PCS algorithm and the use of appropriate PPE to reduce the risk of COVID-19 infection [ 46 , 50 , 55 , 56 ].…”

“…In some research, these care delays did not impact the short-term outcomes. Although there was no significant difference to short-term outcome (follow up with the national institutes of health stroke scale/NIHSS in day 1–3 after MT), there were not long-term follow-up (such as 90 days of the modified rankin scale/mRS) to evaluate the long-term efficacy [ 28 , 29 , 49 , 50 ].…”

Ischemic Stroke: An Underestimated Complication of COVID-19

“…Alharthy et al have shown that in life-threatening COVID-19, especially with immune dysregulation features such as antiphospholipid antibodies, therapeutic plasma exchange could be an effective rescue therapy [109]. Similar to stroke alone, treatment for ischemic stroke in COVID-19 patients is individualized and complicated, including thrombolysis [110,111] and thrombectomy [112,113] for acute interventions and antiplatelets and anticoagulants for secondary prevention. It should be noted that many patients with acute ischemic stroke lose the opportunity for acute intervention because of isolation and reluctance to present to the hospital [114,115].…”