Stroke (04/29/20) doi: 10.1161/STROKEAHA.120.03010
Nguyen, Thanh N.; Abdalkader, Mohamad; Jovin, Tudor G.; et al.
The Society of Vascular and Interventional Neurology (SVIN) has released a guidance statement on acute ischemic large vessel occlusion strokes in an effort to reduce the transmission of COVID-19 and optimize healthcare resources. The document divides treatment for acute stroke into four phases: prehospital to the emergency department, prethrombectomy, thrombectomy intraprocedure, and post-reperfusion therapy. SVIN’s recommendations include screening every acute stroke patient for symptoms and signs of COVID-19 following local protocols; using remote telestroke technology to obtain history and perform neurological examination, if available; and if there is a positive screening for COVID-19, having the patient wear a surgical mask and immediately placing the individual in a negative pressure room in the emergency department. Additional suggestions include preparing all procedural elements in the room prior to patient arrival; considering low-dose chest computerized tomography (CT) at the same time as the performance of CT head and CT angiography head and neck to facilitate diagnosis of COVID-19; alerting the anesthiology provider early of patient with confirmed or suspected infection; and keeping staff to a minimum during the thrombectomy, both to reduce the risk of exposure and conserve protective equipment. “Every opportunity and detail to recalibrate our acute neurological workflow to protect our frontline healthcare workers, our families, our colleagues, and our patients should be sought, implemented, and adapted to a resource-constrained environment,” the researchers write. “It is incumbent upon us to protect each other so that we are not unknowingly exposed or spread to our most vulnerable patients, while at the same time, providing optimal care, patient safety, and access for our patients with stroke.”