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1.
Neurosurgery ; 90(6): 725-733, 2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1724730

ABSTRACT

BACKGROUND: The mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke. OBJECTIVE: To describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. METHODS: We conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020. RESULTS: The total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002). CONCLUSION: COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.


Subject(s)
Brain Ischemia , COVID-19 , Stroke , Brain Ischemia/etiology , Cerebral Infarction/etiology , Humans , Retrospective Studies , Stroke/etiology , Thrombectomy/adverse effects , Treatment Outcome
2.
Clin Neurol Neurosurg ; 209: 106931, 2021 10.
Article in English | MEDLINE | ID: covidwho-1385293

ABSTRACT

OBJECTIVES: The collateral effect of the COVID-19 pandemic on interventional stroke care is not well described. We studied this effect by utilizing stroke device sales data as markers of interventional stroke case volume in the United States. METHODS: Using a real-time healthcare device sales registry, this observational study examined trends in the sales of thrombectomy devices and cerebral aneurysm coiling from the same 945 reporting hospitals in the U.S. between January 22 and June 31, 2020, and for the same months in 2018 and 2019 to allow for comparison. We simultaneously reviewed daily reports of new COVID-19 cases. The strength of association between the cumulative incidence of COVID-19 and procedural device sales was measured using Spearman rank correlation coefficient (CC). RESULTS: Device sales decreased for thrombectomy (- 3.7%) and cerebral aneurysm coiling (- 8.5%) when comparing 2019-2020. In 2020, thrombectomy device sales were negatively associated with the cumulative incidence of COVID-19 (CC - 0.56, p < 0.0001), with stronger negative correlation during April (CC - 0.97, p < 0.0001). The same negative correlation was observed with aneurysm treatment devices (CC - 0.60, p < 0.001), with stronger correlation in April (CC - 0.97, p < 0.0001). CONCLUSIONS: The decline in sales of stroke interventional equipment underscores a decline in associated case volumes. Future pandemic responses should consider strategies to mitigate such negative collateral effects.


Subject(s)
COVID-19/epidemiology , Commerce/trends , Stroke/epidemiology , Thrombectomy/trends , Vascular Access Devices/trends , COVID-19/prevention & control , Humans , Intracranial Aneurysm/epidemiology , Intracranial Aneurysm/therapy , Pandemics , Stroke/therapy , Thrombectomy/economics , United States/epidemiology , Vascular Access Devices/economics
3.
World Neurosurg ; 154: e473-e480, 2021 10.
Article in English | MEDLINE | ID: covidwho-1376112

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an ongoing public health emergency. While most cases end in asymptomatic or minor illness, there is growing evidence that some COVID-19 infections result in nonconventional dire consequences. We sought to describe the characteristics of patients with intracranial hemorrhage who were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Also, with the existing literature, we raise the idea of a possible association between SARS-CoV-2 infection and intracranial hemorrhage and propose possible pathophysiological mechanisms connecting the two. METHODS: We retrospectively collected and analyzed intracranial hemorrhage cases who were also positive for SARS-CoV-2 from 4 tertiary-care cerebrovascular centers. RESULTS: We identified a total of 19 patients consisting of 11 males (58%) and 8 females (42%). Mean age was 52.2, with 95% younger than 75 years of age. With respect to COVID-19 illness, 50% had mild-to-moderate disease, 21% had severe disease, and 20% had critical disease requiring intubation. Of the 19 cases, 12 patients had intraparenchymal hemorrhage (63%), 6 had subarachnoid hemorrhage (32%), and 1 patient had a subdural hematoma (5%). A total of 43% had an intracerebral hemorrhage score of 0-2 and 57% a score of 3-6. Modified Rankin Scale cores at discharge were 0-2 in 23% and 3-6 in 77%. The mortality rate was 59%. CONCLUSIONS: Our series sheds light on a distinct pattern of intracerebral hemorrhage in COVID-19-positive cases compared with typical non-COVID-19 cases, namely the severity of hemorrhage, high mortality rate, and the young age of patients. Further research is warranted to delineate a potential association between SARS-CoV-2 infection and intracranial hemorrhage.


Subject(s)
COVID-19/complications , Intracranial Hemorrhages/epidemiology , Intracranial Hemorrhages/etiology , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/mortality , COVID-19/physiopathology , Female , Hematoma, Subdural/epidemiology , Hematoma, Subdural/etiology , Humans , Intracranial Hemorrhages/mortality , Intubation, Intratracheal , Male , Middle Aged , Retrospective Studies , Subarachnoid Hemorrhage/epidemiology , Subarachnoid Hemorrhage/etiology , Treatment Outcome , Young Adult
8.
J Neurointerv Surg ; 12(9): 831-835, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-626369

ABSTRACT

To assess the impact of COVID-19 on neurovascular research and deal with the challenges imposed by the pandemic. METHODS: A survey-based study focused on randomized controlled trials (RCTs) and single-arm studies for acute ischemic stroke and cerebral aneurysms was developed by a group of senior neurointerventionalists and sent to sites identified through the clinical trials website (https://clinicaltrials.gov/), study sponsors, and physician investigators. RESULTS: The survey was sent to 101 institutions, with 65 responding (64%). Stroke RCTs were being conducted at 40 (62%) sites, aneurysm RCTs at 22 (34%) sites, stroke single-arm studies at 37 (57%) sites, and aneurysm single-arm studies at 43 (66%) sites. Following COVID-19, enrollment was suspended at 51 (78%) sites-completely at 21 (32%) and partially at 30 (46%) sites. Missed trial-related clinics and imaging follow-ups and protocol deviations were reported by 27 (42%), 24 (37%), and 27 (42%) sites, respectively. Negative reimbursements were reported at 17 (26%) sites. The majority of sites, 49 (75%), had put new trials on hold. Of the coordinators, 41 (63%) worked from home and 20 (31%) reported a personal financial impact. Remote consent was possible for some studies at 34 (52%) sites and for all studies at 5 (8%) sites. At sites with suspended trials (n=51), endovascular treatment without enrollment occurred at 31 (61%) sites for stroke and 23 (45%) sites for aneurysms. A total of 277 patients with acute ischemic stroke and 184 with cerebral aneurysms were treated without consideration for trial enrollment. CONCLUSION: Widespread disruption of neuroendovascular trials occurred because of COVID-19. As sites resume clinical research, steps to mitigate similar challenges in the future should be considered.


Subject(s)
Betacoronavirus , Brain Ischemia/therapy , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Randomized Controlled Trials as Topic/methods , Stroke/therapy , Surveys and Questionnaires , Brain Ischemia/diagnosis , Brain Ischemia/epidemiology , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Endovascular Procedures/methods , Endovascular Procedures/trends , Female , Forecasting , Humans , Male , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Stroke/diagnosis , Stroke/epidemiology
10.
J Neurointerv Surg ; 12(7): 643-647, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-327010

ABSTRACT

BACKGROUND: Infection from the SARS-CoV-2 virus has led to the COVID-19 pandemic. Given the large number of patients affected, healthcare personnel and facility resources are stretched to the limit; however, the need for urgent and emergent neurosurgical care continues. This article describes best practices when performing neurosurgical procedures on patients with COVID-19 based on multi-institutional experiences. METHODS: We assembled neurosurgical practitioners from 13 different health systems from across the USA, including those in hot spots, to describe their practices in managing neurosurgical emergencies within the COVID-19 environment. RESULTS: Patients presenting with neurosurgical emergencies should be considered as persons under investigation (PUI) and thus maximal personal protective equipment (PPE) should be donned during interaction and transfer. Intubations and extubations should be done with only anesthesia staff donning maximal PPE in a negative pressure environment. Operating room (OR) staff should enter the room once the air has been cleared of particulate matter. Certain OR suites should be designated as covid ORs, thus allowing for all neurosurgical cases on covid/PUI patients to be performed in these rooms, which will require a terminal clean post procedure. Each COVID OR suite should be attached to an anteroom which is a negative pressure room with a HEPA filter, thus allowing for donning and doffing of PPE without risking contamination of clean areas. CONCLUSION: Based on a multi-institutional collaborative effort, we describe best practices when providing neurosurgical treatment for patients with COVID-19 in order to optimize clinical care and minimize the exposure of patients and staff.


Subject(s)
Betacoronavirus , Coronavirus Infections/surgery , Coronavirus Infections/transmission , Health Personnel/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Neurosurgical Procedures/standards , Pneumonia, Viral/surgery , Pneumonia, Viral/transmission , COVID-19 , Humans , Neurosurgical Procedures/adverse effects , Operating Rooms/methods , Operating Rooms/standards , Pandemics , Personal Protective Equipment/standards , SARS-CoV-2
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