Outcomes of COVID-19 patients with STEMI undergoing primary PCI

Introduction and aim: Coronavirus disease (COVID-19) has substantial impact on acute myocardial infarction (AMI) clinical course and outcome. In Poland during early phase of COVID-19 pandemic a network of dedicated hospitals was set to treat SARS-Cov2 positive patients. There is scarce data on STEMI patients outcome treated in this setting. Our aim was to compare outcomes of STEMI patients treated with primary PCI in hospitals dedicated to treat COVID-19 and referral high volume haemodynamic centres. Method(s): Study was a retrospective analysis of 115 consecutive COVID- 19 patients with STEMI, treated with primary PCI, admitted to 4 high volume centres (2 referral hospitals and 2 COVID dedicated sites) in southern Poland between May 2020 and November 2021. Data was obtained from patients' electronic medical records. Result(s): Detailed characteristics are presented in Table 1 and 2. In general in all hospitals, patients were similar in terms of age (median 69 y.o., IQR: 60-73), with similar profile of comorbidities. All patients used acetylsalicylic acid and unfractioned heparin. In referral centres, as compared with COVID-19 dedicated sites, there was a higher use of mechanical thrombectomy (p<0.001) and adenosine (p<0.001). Overall mortality rate was higher in COVID-19 centres (50% vs 25%, p=0.008). Detailed results are presented in Table 3. Conclusion(s): There is a significantly higher mortality in COVID patients who develop STEMI than in patients with STEMI who were tested positive on admission. Patients in COVID-19 hospitals had higher levels of CRP and NT-proBNP at baseline. There are substantial differences in treatment of patients in referral centres and COVID dedicated hospitals. (Table Presented).

The impact of a two-year long COVID-19 public health restriction program on mechanical thrombectomy outcomes in a stroke network.

OBJECTIVE: The purpose of this study was to evaluate the impact of COVID-19 pandemic public health restrictions on our drip and ship mechanical thrombectomy program in Santiago Chile. MATERIALS AND METHODS: This was a retrospective analysis of a prospectively collected database comparing two cohorts, one during a two-year period before COVID-19 and the second during the two years of the pandemic at our metropolitan stroke program. RESULTS: A total of 100 patients were included in the pre COVID-19 cohort (cohort 1) and 121 in the COVID-19 cohort (cohort 2). There was a significant difference between cohorts, with older patients, different occlusion sites and higher door to arterial puncture time during the COVID-19 period. A non-significant trend for worse 90-day outcomes and higher mortality was present in cohort 2. There were no statistical differences in safety treatment parameters. CONCLUSIONS: COVID-19 pandemic has had a measurable impact on our mechanical thrombectomy program. Results showed similarities to other reported Latin American series, where less robust health systems could adapt less efficiently compared to developed countries. After two years of public health restrictions, there were changes in the treatment population characteristics, delay in some internal management metrics and a non-significant trend to worse 90-day outcomes and higher mortality.

Mechanical thrombectomy for acute multivessel occlusions with duplicated middle cerebral artery: A case report.

Acute multivessel occlusions generally have multisite clot burden with lower successful reperfusion rates, and cerebrovascular anatomical variants increase the challenge of endovascular clot retrieval. We report a case of acute anterior multivessel occlusions patient with duplicated middle cerebral artery. Combined balloon guide catheter with stent retriever and aspiration approach has gained complete revascularization and good functional outcomes at 3 months follow-up.

Hypofibrinogenemia in a Patient with Cardiogenic Shock, Left Ventricular (Lv) Thrombus, Covid-19, and Severe Liver Injury: A Case Report of Complex Decision Making in the Setting of Multiorgan Failure with Unclear Causality

Background We present a case of a young male with new severe cardiomyopathy requiring critical care within 24 hours. Case A Latino male with alcoholism was admitted for COVID and severe liver injury due to alcohol-induced hepatitis. Within hours, he developed hypoxia, worsening metabolic acidosis with undetectable bicarbonate level and partial respiratory compensation, coagulopathy, acute kidney injury, right lower lobe infiltrates without pulmonary embolism. Reduced ejection fraction heart failure at 15-20% with a large left ventricle apical thrombus was also found. Worsening signs of cariogenic shock despite sustaining normal blood pressure was identified on a physical exam. The patient was transferred to ICU with confirmation of cardiogenic shock with right ventricular failure with Swan-Ganz Catheter. With Concern for impending fulminant liver failure, transfer to a tertiary care center for emergent liver transplant was initiated. Decision-making The dichotomy of requirement for anti-coagulation for LV thrombus with cardiogenic shock and worsening coagulopathy due to liver failure was a challenge. Decision was made to transfuse blood products as needed with goal fibrinogen of 150 mg/dl, later changed to 100-120 mg/dl with heparin. Liver enzymes were down-trending, but it was difficult to determine if this was due to recovery or worsening of liver failure with stabilization of hemodynamics. While awaiting transfer, he developed acute cerebrovascular accident requiring emergent mechanical thrombectomy of a left MCA occlusion with suspension of heparin complicated by acute large intraventricular and intraparenchymal hemorrhage with rapid decline in neurological function. The family declined decompressive craniotomy with evacuation of parenchymal hemorrhage and the patient was transitioned to comfort care measures. Conclusion There are no clear guidelines for transfusion of plasma-based blood products in the setting of cardiogenic shock and liver disease. Expert opinion recommends maintaining fibrinogen levels above 100-200 mg/dl, however, this is in the setting of acute blood loss and is not studied in patients with liver disease. Further studies are needed.Copyright © 2023 American College of Cardiology Foundation

Implementing and managing nurse led reviews of patient outcomes at 3 and 6 months following mechanical thrombectomy for acute ischaemic stroke

Introduction: 90% of patients undergoing mechanical thrombectomy (MT) require collection of a 90-day outcome (Sacks et al, 2018). This paper presents the development and operation of a Stroke clinical nurse specialist (CNS) led, telephone thrombectomy outcome clinic at a Comprehensive stroke centre (CSC). The clinic was funded and included within the CNS role. The CNS completed formal mRS training. Service managers created a template for the clinic e.g., appointment duration, frequency, and volume. The CNS curated appointments at 90days & 6 months +/- 14 days. Clinics operated weekly (10-20 patients/month) in structured 15-minute appointments. Multiple 'Did not attend's' (DNA) outcome data was obtained via GP and next of kin. Method(s): Outcome completion and DNA rates were compared from 2019- 2021 from hospital systems. A survey for stroke consultants captured perceived benefits and challenges. Result(s): Outcome completion for 2019 was 97.6% (n=164), 2020 86.9% (n=145) and 2021 99% (n=101). 2020 data was temporarily impacted by stroke CNS staffing change and the coronavirus pandemic. DNA rates reduced between 2019 - 2021 for 3 month (18% to 17%) and 6-month reviews (19% to 11%). 100% of stroke consultants agreed outcome data is vital for the service (6/6). Perceived benefits were quality assurance, standardisation, governance, and clinical continuity. Practical challenges included room availability, following up DNA's and the use of interpreters. Conclusion(s): CSC's can achieve >90% of MT case outcomes with mRS trained CNS led clinics. They provide standardised, reliable, and vital patient outcomes for improving MT services.

A Case of Massive Pulmonary Embolus Extending into a Patent Foramen Ovale: An Impending Catastrophe

Background Massive pulmonary embolus (PE) is a life-threatening condition, however thrombus in transit in the setting of patent foramen ovale (PFO) poses catastrophic risk including systemic thromboembolism. Case An 88 year-old with history of COVID-related PE in 2020 previously on anticoagulation (AC) presented with chest pain & dyspnea. She was found to have lower extremity DVTs & extensive PE in the main pulmonary arteries & its branches. Transthoracic echo (TTE) revealed severe right ventricular dysfunction & right atrial (RA) thrombus in transit that extended into a PFO with right to left shunt. She was hemodynamically stable, but hypoxic on 4L/min of oxygen with a ProBNP 7712 pg/L, Troponin T 104 ng/dl, & pulmonary embolism severity (PESI) score of 104 (10% risk of 30 day mortality). Decision-making Due to the high PESI score & thrombus burden with risk of systemic thromboembolism, a multidisciplinary PE Response Team reached a consensus to pursue urgent mechanical thrombectomy. Inari FlowTriever system was successfully used for thrombectomy & retrieval of the RA clot in transit, with rapid improvement in right sided pressures. Repeat TTE showed no residual clot or shunting. Patient was placed on AC with plan for future PFO closure. Conclusion A multidisciplinary team approach was pivotal in managing this complex case with potential for hemodynamic compromise & systemic thromboembolism. We also demonstrate that mechanical thrombectomy is a feasible strategy for retrieving RA clot in transit. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

CRT-300.19 Trends and Disparities in Patients With Acute Pulmonary Embolism With and Without Cor Pulmonale Undergoing Percutaneous Mechanical Thrombectomy: A National Inpatient Sample Database Study

Background: Percutaneous mechanical thrombectomy is an increasingly utilized treatment modality for acute pulmonary embolism (PE), improving pulmonary flow with embolus/thrombus modification. We aimed to investigated national trends and outcomes in patients with acute pulmonary embolism with and without cor pulmonale undergoing mechanical thrombectomy. Method(s): We utilized the National Inpatient Sample (NIS) Database 2016-2020 to identify the cohort with principal diagnosis of acute pulmonary embolism, with or without cor pulmonale using ICD-10 codes. Patients who had COVID-19 infection during hospital stay were excluded from the 2020 database. Primary outcome analysis included adjusted inpatient mortality rate utilizing predictive margins, during each calendar year stratified by sex, age, race, and median household income (MHOI). Result(s): There were a total of 389,527 hospitalizations (367,205 without cor pulmonale;22,322 with cor pulmonale) with a principal diagnosis of acute PE from 2016-2020. Out of these hospitalizations, 3,168 (0.81%) underwent mechanical thrombectomy during hospital stay. Ratio of mechanical thrombectomy amongst all PEs increased significantly throughout the years (0.39% in 2016 vs 1.68% in 2020, p trend <0.001). There was a significant decline in mortality of patients without cor pulmonale undergoing mechanical thrombectomy (12.72% in 2016 vs. 8.30% in 2020, p-trend <0.001), however this trend was not observed in patients with cor pulmonale (12.11% in 2016 vs. 8.87% in 2020, p-trend = 0.45). Conclusion(s): Our findings suggest that, throughout the years of 2016-2020, there was a trend suggesting an increase in ratio of mechanical thrombectomy amongst patients admitted with pulmonary embolism and decrease in inpatient mortality in patients without cor pulmonale undergoing mechanical thrombectomy. [Formula presented]Copyright © 2023

A successful thrombectomy in a case of progressive cerebral sinus thrombosis

Introduction: Cerebral venous sinus thrombosIs (CVST) is a rare condition compared to other categories encountered in stroke medicine.It occurs more frequently in patients with conditions that predispose them to other venous thrombosis, such as thrombophilias, acute malignancies, nephrotic syndrome, and COVID-19. CVST was identified as one of the rare causative of stroke. The exact mechanism of the stroke is not fully understood. However, a commonly agreed pathophysiology is that a dysfunction in arachnoid granulation can lead to sinus occlusion. Subsequently, this leads to a reduction in cerebral fluid drainage, which can increase intracranial pressure, causing capillary hypertension, cerebral oedema, decrease in cerebral perfusion pressure and venous haemorrhage. The European Stroke Organisation (ESO) supports using both MRI/MR Venogram and CT venogram as modalities for diagnosis of CVST, with no particular preference of one over the other. The standard practice in the management of cerebral venous sinus thrombosis includes treating the clot and its precipitating factors and treating the sequela of the clot as in the case we are reporting. Yet, there is no clinical guideline for the more aggressive measures to break down the clot in either AHA or European Stroke Organization, but they are used in clinical practice, with promising results in certain cases. Our case is an example of a successful mechanical thrombectomy with a lifesaving outcome. Method(s): We are reporting an unusual case of a 27- year- old lady who presented to the hyperacute stroke unit with dense right- sided weakness and expressive dysphasia. After an initial CT (Computerised Tomography) scan confirming extensive cerebral venous sinus thrombosis, she went for urgent mechanical thrombectomy. The clinical assessment after the procedure showed significant recovery in power of the right limbs and speech. She was discharged 7 days later with near full recovery. Venous thrombectomy is a rarely performed procedure. However, in this case, it was potentially lifesaving and resulted in an excellent clinical outcome. Result(s): An MRI/MRV follow up in a month demonstrated that the lesion on left centrum semiovale had regressed compared to the first scan. Also, there was some evidence of recanalization of her transverse sinuses. She was assessed by the therapist two months from the event. The patient reported some word finding difficulties and clumsiness in the right hand and leg. However, no further major event since her thrombectomy, and now aiming to get back to work. Conclusion(s): Mechanical thrombectomy in cerebral venous sinus thrombosis can be an effective, life-saving, and safe procedure with an extremely rewarding outcome. It should be considered in patients with acute neurological deterioration despite anticoagulant therapy.

Acute Myocardial Infarction in a Young Male With COVID-19 Infection.

Coronavirus disease 2019 (COVID-19) infection is a global health crisis resulting in significant morbidity and mortality. The presentation of COVID-19 infection is variable, ranging from an asymptomatic carrier state to multi-organ failure. While cases of COVID-related myocarditis and myocardial dysfunction are well reported, only a few cases of coronary artery thrombosis resulting in myocardial infarction are noted on literature review. However, the previously reported cases were in patients with high risk for coronary artery disease. We hereby report a case of a young man with no significant past medical history or cardiovascular risk factors who presented with severe chest pain and was diagnosed with acute myocardial infarction in the setting of COVID-19 infection requiring intervention. We want to report this case to improve awareness in the community about COVID-related arterial thrombosis and have a high index of suspicion for this regardless of the person's risk factors for cardiovascular diseases.

The decline in stroke hospitalization due to COVID-19 is unrelated to COVID-19 intensity.

BACKGROUND AND PURPOSE: During the coronavirus disease 2019 (COVID-19) pandemic many countries reported a decline in stroke volumes. The aim of this study was to analyze if the decline was related to the intensity of the COVID-19 pandemic. METHODS: The first pandemic year (1 March 2020 to 28 February 2021) overall and during the three COVID-19 waves were compared with the preceding year. Volumes of acute ischaemic stroke (AIS), subarachnoid hemorrhage, intracerebral hemorrhage and recanalization treatments (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]) were obtained from the National Register of Reimbursed Health Services. Door-to-needle time, onset-to-door time and National Institutes of Health Stroke Scale at admission were obtained from the Registry of Stroke Care Quality. RESULTS: During the pandemic year compared to the preceding year there were 26,453 versus 28,771 stroke admissions, representing an 8.8% decline (p < 0.001). The declines (-10%, -11%, -19%) appeared in COVID-19 waves (spring 2020, autumn 2020, winter 2021) except for an increase (2%) during summer 2020. Admissions for AIS declined by 10.2% (p < 0.001), whilst hemorrhagic stroke volumes were minimally decreased. The absolute volumes of IVT and MT decreased by 9.4% (p < 0.001) and 5.7% (p = 0.16), respectively. However, the proportions of ischaemic stroke patients receiving IVT (18% vs. 18%; p = 0.72) and MT (6% vs. 6%; p = 0.28) remained unchanged. CONCLUSIONS: There was a decline in stroke admissions, but such decline was not related to COVID-19 incidence. The frequency of use of recanalization procedures (IVT, MT) and times (onset-to-door time, door-to-needle time) in AIS were preserved in the Czech Republic during the first year of the pandemic.

Establishing a hyperacute stroke service during the COVID-19 pandemic: our institution's one year experience.

BACKGROUND AND AIMS: The corononavirus 2019 (COVID-19) pandemic resulted in modifications in the workflow and redistribution of human resources, causing challenges in setting up of an acute stroke service. We would like to share our preliminary outcome amid this pandemic, to determine if the implementation of COVID-19 standard operating procedures (SOPs) affected the delivery of our hyperacute stroke service. METHODS: We retrospectively analyzed one-year data from our stroke registry that began with the establishment of our hyperacute stroke service at Universiti Putra Malaysia Teaching Hospital from April 2020 until May 2021. RESULTS: Setting up acute stroke services during the pandemic with constrained manpower and implementation of COVID-19 SOPs, was challenging. There was a significant dip of stroke admission from April to June 2020 due to the Movement Control Order (MCO) implemented by the government to curb the spread of COVID-19. However, the numbers of stroke admission steadily rose approaching 2021, after the implementation of recovery MCO. We managed to treat 75 patients with hyperacute stroke interventions i.e. intravenous thrombolysis (IVT), mechanical thrombectomy (MT) or both. Despite implementing COVID-19 SOPs and using magnetic resonance imaging (MRI) as our first line acute stroke imaging modality, clinical outcomes in our cohort were encouraging; almost 40% of patients who underwent hyperacute stroke treatment had early neurological recovery (ENR), and only 33% of patients had early neurological stability (ENS). In addition, we were able to maintain our door-to-imaging (DTI) and door-to-needle (DTN) time in line with international recommendations. CONCLUSIONS: Our data reflects that COVID-19 SOPs did not deter successful delivery of hyperacute stroke services in our center. However, bigger and multi center studies are required to support our findings.

The impact of COVID 19 on the outcomes of thrombectomy in stroke patients: A systematic review and meta-analysis.

We aimed to conduct the current meta-analysis to provide better insight into the efficacy of mechanical thrombectomy (MT) in managing COVID-19 patients suffering from a stroke. An electronic search was conducted through eight databases for collecting the current evidence about the efficacy of MT in stroke patients with COVID-19 until 18 December 2021. The results were reported as the pooled prevalence rates and the odds ratios (ORs), with their corresponding 95% confidence intervals (CI). Out of 648 records, we included nine studies. The prevalence of stroke patients with COVID-19 who received MT treatment was with TICI ≥2b 79% (95%CI: 73-85), symptomatic intracranial haemorrhage 6% (95%CI: 3-11), parenchymal haematoma type 1, 11.1% (95%CI: 5-23), and mortality 29% (95%CI: 24-35). On further comparison of MT procedure between stroke patients with COVID 19 to those without COVID-19, we found no significant difference in terms of TICI ≥2b score (OR: 0.85; 95%CI: 0.03-23; p = 0.9). However, we found that stroke patients with COVID-19 had a significantly higher mortality rate than stroke patients without COVID-19 after MT procedure (OR: 2.99; 95%CI: 2.01-4.45; p < 0.001). Stroke patients with COVID-19 can be safely and effectively treated with MT, with comparable reperfusion and complication rates to those without the disease.

Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: One-Year Follow-up.

BACKGROUND AND OBJECTIVES: Declines in stroke admission, intravenous thrombolysis, and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the impact of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), intravenous thrombolysis (IVT), and mechanical thrombectomy over a one-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). METHODS: We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, intravenous thrombolysis treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS: There were 148,895 stroke admissions in the one-year immediately before compared to 138,453 admissions during the one-year pandemic, representing a 7% decline (95% confidence interval [95% CI 7.1, 6.9]; p<0.0001). ICH volumes declined from 29,585 to 28,156 (4.8%, [5.1, 4.6]; p<0.0001) and IVT volume from 24,584 to 23,077 (6.1%, [6.4, 5.8]; p<0.0001). Larger declines were observed at high volume compared to low volume centers (all p<0.0001). There was no significant change in mechanical thrombectomy volumes (0.7%, [0.6,0.9]; p=0.49). Stroke was diagnosed in 1.3% [1.31,1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82,2.97], 5,656/195,539) of all stroke hospitalizations. DISCUSSION: There was a global decline and shift to lower volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared to the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year. TRIAL REGISTRATION INFORMATION: This study is registered under NCT04934020.

Management of acute ischemic stroke in patients with COVID-19 infection: Insights from an international panel.

OBJECTIVE: To present guidance for clinicians caring for adult patients with acuteischemic stroke with confirmed or suspected COVID-19 infection. METHODS: The summary was prepared after review of systematic literature reviews,reference to previously published stroke guidelines, personal files, and expert opinionby members from 18 countries. RESULTS: The document includes practice implications for evaluation of stroke patientswith caution for stroke team members to avoid COVID-19 exposure, during clinicalevaluation and conduction of imaging and laboratory procedures with specialconsiderations of intravenous thrombolysis and mechanical thrombectomy in strokepatients with suspected or confirmed COVID-19 infection. RESULTS: Conclusions-The summary is expected to guide clinicians caring for adult patientswith acute ischemic stroke who are suspected of, or confirmed, with COVID-19infection.

Mechanical Thrombectomy in Acute Ischemic Stroke COVID-19 and Non-COVID-19 Patients: A Single Comprehensive Stroke Center Study.

Coronavirus disease 2019 (COVID-19) increases the risk for thromboembolic events, such as acute ischemic stroke (AIS). Mechanical thrombectomy (MT) is a therapy of choice in early diagnosed AIS; however, its success and outcomes in COVID-19 patients are contradictory. This study presented our experience with MT performed in COVID-19 patients compared to a control group. The retrospective analysis included patients with AIS who underwent MT from April 2021 to April 2022 at our institution. There were 13 COVID-19-related patients (with active or past COVID-19 infection) and 55 non-COVID-19 patients (negative COVID-19 status). We analyzed patients' baseline clinical and laboratory data, modified Thrombolysis in Cerebral Infarction (mTICI) scale, used 24 h follow-up CT findings, and modified the Rankin scale. The COVID-19 group had higher values of leukocytes, neutrophils, neutrophil/leukocyte ratios, ASL, ALT, LDH and CRP, and lower values of lymphocytes compared to the control group. The AIS mostly occurred in posterior circulation in the COVID-19 group, while anterior circulation was more affected in the control group. Treatment approach and successful reperfusion did not differ between groups. In conclusion, although differences in some clinical and laboratory parameters between COVID-19 and non-COVID-19 groups were found, the outcomes of mechanical thrombectomy were equal.

Delayed onset phlegmasia cerulea dolens post-SARS-CoV-2 infection treated with minimally invasive clot retrieval technology.

Coronavirus disease 2019 is associated with a significant venous thromboembolic risk. Phlegmasia cerulean dolens is a severe form of deep vein thrombosis that can lead to acute limb ischemia. In this report, we present a 58-year-old woman who developed a delayed-onset left lower extremity phlegmasia cerulean dolens 8 weeks after coronavirus disease 2019 onset that led to compartment syndrome and acute limb ischemia from external compression of the arterial vasculature from edematous muscle. The patient received an emergent minimally invasive percutaneous mechanical thrombectomy and four-compartment fasciotomy, resulting in adequate perfusion and ultimately made a full recovery.

Stroke treatment during the COVID-19 pandemic.

Studies have reported that COVID-19 is associated not only with pneumonia but also with cerebrovascular disease. Consequently, medical personnel involved in treating stroke in the emergency medicine setting have been placed in a situation that requires them to provide treatment while always remaining mindful of the possibility of COVID-19. Here, we describe the current state of stroke treatment during the COVID-19 pandemic. Four patients with stroke and concomitant COVID-19 were treated at our facility. We treated 3 patients with cerebral infarction and 1 patient with cerebral venous sinus thrombosis. All 3 patients with cerebral infarction had a poor outcome. This was attributed in part to the poor general condition of the patients due to concomitant COVID-19, as well as to the severity of the major artery occlusion and cerebral infarction. One patient with cerebral venous sinus thrombosis had a good outcome. Anticoagulant therapy was administered at our hospital and resulted in a stable clinical course. Our hospital has worked to establish an examination and treatment system that enables mechanical thrombectomy to be performed even during the COVID-19 pandemic. We devised a protocol showing the steps to be taken from initial treatment to admission to the cerebral angiography room. Our hospital was able to continue accepting requests for emergency admission thanks to the examination and treatment system we established. Up-to-date information should continue to be collected to create examination and treatment systems.

Maintaining the Quality of Mechanical Thrombectomy after Acute Ischemic Stroke in COVID(-)19 Patients.

The COVID-19 pandemic has become increasingly worse worldwide since it was discovered in China in late December 2019. Easy contact transmission between people and a low to moderate mortality rate may cause failure in medical health services if there is no proper personal protective equipment for personnel. During the pandemic, patients with acute ischemic stroke with large-vessel occlusion who required immediate treatment through mechanical thrombectomy (MT) were still being sent to the emergency room. Knowing how to maintain effective treatment standards has become our concern. We used a retrospective, single-center study to select COVID-19 (-) patients with acute ischemic stroke undergoing mechanical thrombectomy during the years 2020-2021. Patients with acute ischemic stroke with large-vessel occlusion received mechanical thrombectomy were compared with patients admitted from December 2020 to May 2021 (the pre-COVID-19 group) and those from June 2021 to November 2021 (the during COVID-19 group). Furthermore, the time disparity of mechanical thrombectomy was compared between these two groups. Of patients confirmed with acute ischemic stroke (AIS) with large-vessel occlusion (LVO) during the study period, 62 were included. Compared with the pre-COVID-19 group (34 patients; median age, 70.5 years), the during COVID-19 group (28 patients; median age, 71.5 years) showed no major median time difference in door-to-computed-tomography-angiography (CTA) time (19.0 min vs. 20.0 min, p = 0.398) and no major median time difference in door-to-groin-puncture time (118.0 min vs. 109.0 min, p = 0.281). In our study, with a prepared protocol for the pandemic having been established in the healthcare system, we could see no difference between the pre-pandemic and during-pandemic time periods when using mechanical thrombectomy to treat COVID-19 (-) patients of AIS with LVO. By means of a quick-PCR test during triage, there was no time delay to perform MT or any lowering of safety protocol for workers in the healthcare system.

Aspiration mechanical thrombectomy in acute and subacute iliofemoral deep vein thrombosis in the COVID era: challenges and outcome

BACKGROUND: Catheter directed thrombolysis (CDT) proved to be effective treatment in deep venous thrombosis (DVT), However, there is some concerns about the associated bleeding risk. We assessed the safety and efficacy including technical and clinical success in resolution of iliofemoral DVT after one session treatment with penumbra aspiration mechanical thrombectomy catheter as an alternative CDT. METHOD(S): This is a retrospective study that was conducted on patients presented to Aseer Central Hospital and Saudi German Hospital in Saudi Arabia from January 2019 to December 2020 with symptomatic acute iliofemoral DVT. Patients were treated with Indigo continuous aspiration mechanical thrombectomy 8 system (Penumbra Inc, Alameda, CA, USA). Secondary end point was treatment complications, DVT recurrence and postphlebetic syndrome occurrence within 1 year follow-up. RESULT(S): Our study included twenty-three patients with sixteen females (59.6%) and seven males (30.4%) with a median age of 38 years (18-60years). Indication for treatment was primary DVT in seventeen patients (73.9%), recurrent DVT in six patients (26.1%). Provoked DVT was present in fifteen patients (65.2%) with nine of them was tested positive for COVID-19 while non provoked DVT in eight patients (4.8%). Seven patients (30.4%) had underlying May-Thurner Syndrome after thrombus removal and needed stenting for left common iliac vein (CIV) and two patients (8.7%) with recurrent DVT has significant residual Left common iliac vein stenosis that needed stenting. Two patient (8.7%) have thrombosis extending to inferior vena cava. Initial technical success using Penumbra was 82.6%. All patients in whom aspiration thrombectomy was not successful underwent further treatment with CDT which was successful in further three cases with failure in one case making overall technical success was 95.7%. Recurrent iliac occlusion after successful recanalization was seen in two patients (8.7%) at 6 months follow up. One patient (4.3%) developed pulmonary embolism that required full anticoagulation with no further treatment. No patient develops postphlebetic syndrome at 1 year follow-up. CONCLUSION(S): Penumbra aspiration thrombectomy catheter was safe, effective and promising technique in treatment of acute iliofemoral DVT and allowed definitive treatment in one session with no need for the use of thrombolysis in the majority of cases with no risk for bleeding complications, shorter hospital stay, no need for ICU admission and lower cost. COVID infection does not seem to alter the outcome. Copyright © 2022 EDIZIONI MINERVA MEDICA.

A report of 2 cases of the use of the Inari FlowTriever System in the treatment of pulmonary embolism.

The FlowTriever System (Inari Medical, Irvine, California) is the first FDA-approved mechanical thrombectomy device used for treatment of pulmonary embolism. This device enables nonsurgical removal of pulmonary blood clots without the use of thrombolytic medication and its associated risks. We report 2 cases of successful application of the Inari FlowTriever in treatment of pulmonary embolism and right atrial thrombus.