Abstract
The current coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 has led to immense strain on healthcare systems and workers. Patients with severe symptoms of COVID-19 may also present with acute neurological emergencies such as ischemic stroke. Ischemic stroke in these patients may result from COVID-19 related complications or decompensation of previously asymptomatic cerebrovascular disorders, or concurrent ischemic stroke from common stroke risk factors in a patient with COVID-19. Acute ischemic stroke patients with large vessel occlusions require emergent triage, intensive care, and mechanical thrombectomy. Management of patients with large vessel occlusions (LVO) requires special considerations in the current pandemic. Physicians must now account for prognosis of severe COVID-19, resource utilization, and risk of infection to healthcare workers when determining eligibility for mechanical thrombectomy (MT). Here, we describe important prognostic factors including age, laboratory, and imaging findings to consider for MT selection and provide suggestions for taking care of patients with LVO and possible or confirmed COVID-19. It is recommended to perform MT in patients within the established guidelines, and consider a conservative approach in cases where there is clinical equipoise to minimize futile reperfusion. Lastly, we describe an illustrative case of a patient with ischemic stroke and COVID-19.
Highlights
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China [1]
COVID-19 has placed an unprecedented strain on healthcare systems and resources
Our review summarizes the clinical presentation of COVID-19 and provides prognostic features of severe COVID-19 infection to help determine the risks and benefits of performing mechanical thrombectomy (MT)
Summary
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China [1]. The United States (US) leads the world in the number of COVID19 cases, and there are growing concerns regarding the potential strain on its healthcare systems due to the intensive care needed for critically ill COVID-19 patients [2]. Initial reports from other countries have already highlighted the stress of COVID-19 on their intensive care units (ICU) and resources [3]. A recent case series of critically ill COVID-19 patients in Seattle, Washington reported a median ICU stay of 14 days and a median duration of mechanical ventilation of 10 days [4]. With emergency departments and ICUs triaging and caring for increasing numbers of COVID19 patients, there is little doubt that the COVID-19 pandemic will have a tremendous impact on available resources for the triage and treatment of acute ischemic stroke (AIS). We present an overview of COVID-19, recommendations for acute stroke care and treatment, and provide an illustrative case study of stroke in a COVID-19 positive patient
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
