Mechanical Thrombectomy of COVID-19 positive acute ischemic stroke patient: a case report and call for preparedness
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CASE REPORT
Open Access
Mechanical Thrombectomy of COVID-19 positive acute ischemic stroke patient: a case report and call for preparedness Ossama Yassin Mansour1* , Amer M. Malik2 and Italo Linfante3
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. Keywords: Acute ischemic stroke, Mechanical thrombectomy, COVID-19, Coronavirus, SARS-CoV-2, Stroke workflow, Personal protective equipment, Large vessel occlusion
Background The first case of SARS-CoV-2 infection in Wuhan Province of China in December 2019 [1]. As of 29 Feb. 2020, the number of laboratory-confirmed COVID-19 cases has exceeded 500,000 cases globally [2]. The clinical presentation of COVID-19 patients varies considerably, ranging from asymptomatic infection to severe pneumonia that may lead to respiratory failure and death [3]. Recently, Li et al. performed a meta-analysis of six studies reporting data on COVID-19 patients. The authors reported the * Correspondence: [email protected] 1 Neurology Department, Stroke and Neurointerventional Unit, Alexandria University, Faculty of Medicine, Alexandria, Egypt Full list of author information is available at the end of the article
presence of cardiac and cerebrovascular diseases in16.4% of this population. In addition, they reported that the incidence of vascular disease was three-fold higher among severe COVID-19 patients requiring ICU care [4] In addition, Li YaB et al. reported that 13 of 221 (5.8%) of the cases who suffered from a SARS-CoV-2 infection developed acute cerebrovascular disease (CVD), possibly related to the prothrombotic effect of the host inflammatory response to the virus. Older patients
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