Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics

Wang, Arthur; Mandigo, Grace K; Yim, Peter D.; Meyers, Philip M.; Lavine, Sean D.

doi:10.1136/neurintsurg-2020-016220

Cited by 119 publications

(144 citation statements)

References 12 publications

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“…A total sample of 8,771 participants was included in the systematic review. These studies were conducted in many countries worldwide including in China ( 13 , 40 , 43 ), France ( 37 , 39 , 48 , 50 ), India ( 42 ), Iran ( 51 ), Italy ( 32 , 33 , 46 ), the Netherlands ( 34 ), Philippines ( 52 ), Spain ( 44 , 53 ), Turkey ( 58 ), UK ( 41 , 55 ), and the USA ( 21 , 35 , 36 , 45 , 47 , 49 , 54 , 56 , 57 ). Out of 27 studies, eight studies were of retrospective cohort study design, 11 were case series, and nine were case reports.…”

Section: Resultsmentioning

confidence: 99%

“…The numbers of stroke were almost equal for LVO (47 stroke cases in 10 studies) and non-LVO (42 cases in 10 studies). Location of LVOs involved were M1 vessels ( 21 , 37 , 41 , 42 , 44 , 45 , 47 , 53 , 54 ), M2 vessel ( 41 , 42 , 44 , 45 , 47 , 53 ), internal carotid ( 21 , 37 , 42 , 45 , 47 , 53 ), multiteritorial ( 37 , 47 ), posterior cerebral ( 41 , 45 ), basilar ( 37 ), ACA ( 21 , 53 ), and the vertebral artery ( 41 ).…”

Section: Resultsmentioning

confidence: 99%

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Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis

et al. 2020

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Background: As the world witnessed the devastation caused by the coronavirus disease 2019 (COVID-19) outbreak, a growing body of literature on COVID-19 is also becoming increasingly available. Stroke has increasingly been reported as a complication of COVID-19 infection. However, a systematic synthesis of the available data has not been conducted. Therefore, we performed a systematic review and meta-analysis of currently available epidemiological, clinical, and laboratory data related to both stroke and COVID-19 infection. Methods: We systematically searched Medline, Cinahl, and PubMed for studies related to stroke and COVID-19 from inception up to June 4, 2020. We selected cohort studies, case series, and case reports that reported the occurrence of stroke in COVID-19 patients. A fixed-effects model was used to estimate the pooled frequency of stroke in COVID-19 patients with a 95% confidence interval (CI). Results: Twenty-eight studies were included in the systematic review and seven studies for the meta-analysis. The pooled frequency of stroke in COVID-19 patients was 1.1% (95% CI: 0.8, 1.3). The heterogeneity was low ( I 2 = 0.0%). Even though the frequency of stroke among patients having COVID-19 infection was low, those with concomitant COVID-19 infection and stroke suffered from a more severe infection and eventually had a poorer prognosis with a higher mortality rate (46.7%) than COVID-19 alone. Many COVID-19 patients shared the common traditional risk factors for stroke. We noted that ischemic stroke involving the anterior circulation with large vessels occlusion is the most common type of stroke with more strokes seen in multi-territorial regions, suggesting systemic thromboembolism. An elevated level of D-dimers, C-reactive protein, ferritin, lactic acid dehydrogenase, troponin, ESR, fibrinogen, and a positive antiphospholipid antibody were also noted in this review. Conclusions: The occurrence of stroke in patients with COVID-19 infection is uncommon, but it may pose as an important prognostic marker and indicator of severity of infection, by causing large vessels occlusion and exhibiting a thrombo-inflammatory vascular picture. Physicians should be made aware and remain vigilant on the possible two-way relationship between stroke and COVID-19 infection. The rate of stroke among patients with COVID-19 infection may increase in the future as they share the common risk factors.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis

et al. 2020

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“…This is a report of a COVID 19 patient with AIS secondary due to LVO that underwent successful MT with excellent clinical and angiographic outcome in contrary to majority of reported case prognosis [ 7 ]. Patients with COVID-19 infection, and in particular those requiring ICU care, are more at risk to develop CVD and stroke 4 .…”

Section: Discussionmentioning

confidence: 99%

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

2020

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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.

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“…The clinical outcomes were noted to be worse in our COVID patients who underwent EVT in a timely manner in comparison with non-COVID patients [18]. These ndings could be related to sequalae of clot fragments and migration of microemboli as described by Wang et al and suggested to be related to the clot composition in COVID-19 patients [15], in addition to the severity of the underlying COVID-19 disease that in conjunction with stroke indicates a worse overall prognosis [6].…”

Section: Discussionmentioning

confidence: 60%

“…Additionally, SARS-CoV-2 pandemic has led to a signi cant decrease in the number of stroke cases presenting to the hospitals, prolonged time from symptoms to hospital arrival and reperfusion [7,8,13]. Furthermore, protocols have been suggested to ensure the safety of stroke team personnel during the pandemic but there is no change in the criteria for mechanical thrombectomy [14,15].…”

Section: Discussionmentioning

confidence: 99%

Mechanical Thrombectomy of Large Vessel Occlusions in COVID-19 Related Stroke: Endovascular and Clinical Outcomes

Al-Smadi

Abrol

Luqman

et al. 2020

Preprint

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Background and PurposeStroke is a drastic complication and a poor prognostic marker of COVID-19 disease which emphasizes the importance of early identification and management of this complication. In this case series, we describe our experience of mechanical thrombectomy of large vessel occlusions (LVO) in patients with COVID-19.MethodsWe performed a retrospective study of a series of confirmed COVID-19 patients who underwent endovascular thrombectomy for acute cerebrovascular ischemic disease with large vessel occlusion. Patient demographics, presentations, lab values, angiographic and clinical outcomes were also reviewed.ResultsThree COVID-19 patients with large vessel occlusion who underwent endovascular thrombectomy were identified in our multi-center institution. Two patients had respiratory symptoms prior presentation and one patient presented initially with clinical deficits. Two patients had anterior circulation occlusion in the middle cerebral artery territory vs one had posterior circulation occlusion in the basilar artery. There was good angiographic outcome post thrombectomy in all patients, however poor clinical outcomes noted with no significant improvement in neurological manifestations in comparison with baseline at presentation. All patients developed critically severe symptoms during hospitalization requiring intubation and one patient died of COVID-19 related respiratory failure.ConclusionIn this small case series, we noted worse clinical outcomes in COVID-19 related LVO stroke despite effective thrombectomy, which may be related to the underlying COVID-19 disease and/or the nature of clot in these patients.

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Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics

Cited by 119 publications

References 12 publications

Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis

Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis

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

Mechanical Thrombectomy of Large Vessel Occlusions in COVID-19 Related Stroke: Endovascular and Clinical Outcomes

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