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1.
Interv Neuroradiol ; 26(5): 557-565, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1455862

ABSTRACT

BACKGROUND: The Low-profile Visualized Intraluminal Support device (LVIS) has been successfully used to treat cerebral aneurysm, and the push-pull technique has been used clinically to compact the stent across aneurysm orifice. Our aim was to exhibit the hemodynamic effect of the compacted LVIS stent. METHODS: Two patient-specific aneurysm models were constructed from three-dimensional angiographic images. The uniform LVIS stent, compacted LVIS and Pipeline Embolization Device (PED) with or without coil embolization were virtually deployed into aneurysm models to perform hemodynamic analysis. Intra-aneurysmal flow parameters were calculated to assess hemodynamic differences among different models. RESULTS: The compacted LVIS had the highest metal coverage across the aneurysm orifice (case 1, 46.37%; case 2, 67.01%). However, the PED achieved the highest pore density (case 1, 19.56 pores/mm2; case 2, 18.07 pores/mm2). The compacted LVIS produced a much higher intra-aneurysmal flow reduction than the uniform LVIS. The PED showed a higher intra-aneurysmal flow reduction than the compacted LVIS in case 1, but the results were comparable in case 2. After stent placement, the intra-aneurysmal flow was further reduced as subsequent coil embolization. The compacted LVIS stent with coils produced a similar reduction in intra-aneurysmal flow to that of the PED. CONCLUSIONS: The combined characteristics of stent metal coverage and pore density should be considered when assessing the flow diversion effects of stents. More intra-aneurysmal flow reductions could be introduced by compacted LVIS stent than the uniform one. Compared with PED, compacted LVIS stent may exhibit a flow-diverting effect comparable to that of the PED.


Subject(s)
Embolization, Therapeutic/methods , Intracranial Aneurysm/therapy , Stents , Subarachnoid Hemorrhage/therapy , Angiography, Digital Subtraction , Cerebral Angiography , Computer Simulation , Hemodynamics , Humans , Hydrodynamics , Imaging, Three-Dimensional , Intracranial Aneurysm/diagnostic imaging , Magnetic Resonance Angiography , Prosthesis Design , Subarachnoid Hemorrhage/diagnostic imaging
2.
PLoS One ; 16(4): e0248728, 2021.
Article in English | MEDLINE | ID: covidwho-1183650

ABSTRACT

OBJECTIVE: To examine the outcomes of adult patients with spontaneous intracranial and subarachnoid hemorrhage diagnosed with comorbid COVID-19 infection in a large, geographically diverse cohort. METHODS: We performed a retrospective analysis using the Vizient Clinical Data Base. We separately compared two cohorts of patients with COVID-19 admitted April 1-October 31, 2020-patients with intracerebral hemorrhage (ICH) and those with subarachnoid hemorrhage (SAH)-with control patients with ICH or SAH who did not have COVID-19 admitted at the same hospitals in 2019. The primary outcome was in-hospital death. Favorable discharge and length of hospital and intensive-care stay were the secondary outcomes. We fit multivariate mixed-effects logistic regression models to our outcomes. RESULTS: There were 559 ICH-COVID patients and 23,378 ICH controls from 194 hospitals. In the ICH-COVID cohort versus controls, there was a significantly higher proportion of Hispanic patients (24.5% vs. 8.9%), Black patients (23.3% vs. 20.9%), nonsmokers (11.5% vs. 3.2%), obesity (31.3% vs. 13.5%), and diabetes (43.4% vs. 28.5%), and patients had a longer hospital stay (21.6 vs. 10.5 days), a longer intensive-care stay (16.5 vs. 6.0 days), and a higher in-hospital death rate (46.5% vs. 18.0%). Patients with ICH-COVID had an adjusted odds ratio (aOR) of 2.43 [1.96-3.00] for the outcome of death and an aOR of 0.55 [0.44-0.68] for favorable discharge. There were 212 SAH-COVID patients and 5,029 controls from 119 hospitals. The hospital (26.9 vs. 13.4 days) and intensive-care (21.9 vs. 9.6 days) length of stays and in-hospital death rate (42.9% vs. 14.8%) were higher in the SAH-COVID cohort compared with controls. Patients with SAH-COVID had an aOR of 1.81 [1.26-2.59] for an outcome of death and an aOR of 0.54 [0.37-0.78] for favorable discharge. CONCLUSIONS: Patients with spontaneous ICH or SAH and comorbid COVID infection were more likely to be a racial or ethnic minority, diabetic, and obese and to have higher rates of death and longer hospital length of stay when compared with controls.


Subject(s)
COVID-19/epidemiology , Cerebral Hemorrhage/therapy , Subarachnoid Hemorrhage/therapy , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Cerebral Hemorrhage/epidemiology , Cerebral Hemorrhage/mortality , Child , Child, Preschool , Cohort Studies , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Infant , Length of Stay , Male , Middle Aged , Minority Groups , Patient Discharge , Retrospective Studies , SARS-CoV-2/isolation & purification , Subarachnoid Hemorrhage/epidemiology , Subarachnoid Hemorrhage/mortality , Treatment Outcome , United States/epidemiology
3.
Neurol Sci ; 42(6): 2167-2172, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1141440

ABSTRACT

BACKGROUND: Acute subarachnoid hemorrhage (SAH) due to aneurysmal rupture is a devastating vascular disease accounting for 5% of strokes. COVID-19 pandemic resulted in a decrease in elective and emergency admissions in the majority of neurosurgical centers. The main hypothesis was that fear of COVID-19 may have prevented patients with critical medical or surgical emergencies from actively presenting in emergency departments and outpatient clinics. METHODS: We conducted a single-center, retrospective, observational study searching our institutional data regarding the incidence of spontaneous subarachnoid hemorrhage (SAH) and compare the admissions in two different periods: the pre COVID-19 with the COVID-19 period. RESULTS: The study cohort was comprised of a total of 99 patients. The mean (SD) weekly case rate of patients with SAH was 1.1 (1.1) during the pre-COVID-19 period, compared to 1.7 (1.4) during the COVID-19 period. Analysis revealed that the volume of admitted patients with SAH was 1.5-fold higher during the COVID period compared to the pre-COVID period and this was statistically significant (ExpB = 1.5, CI 95% 1-2.3, p = 0.044). Difference in mortality did not reach any statistical significance between the two periods (p = 0.097), as well as patients' length of stay (p = 0.193). CONCLUSIONS: The presented data cover a more extended time period than so far published reports; it is reasonable that our recent experience may well be demonstrating a general realistic trend of overall increase in aneurysmal rupture rates during lockdown. Hospitalization of patients with SAH cannot afford any reductions in facilities, equipment, or personnel if optimum outcomes are desirable.


Subject(s)
COVID-19 , Subarachnoid Hemorrhage , Communicable Disease Control , Greece/epidemiology , Hospitalization , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Subarachnoid Hemorrhage/epidemiology , Subarachnoid Hemorrhage/therapy
5.
Perfusion ; 36(5): 524-528, 2021 07.
Article in English | MEDLINE | ID: covidwho-751302

ABSTRACT

In this report, we describe the case of a 5-year-old male with SARS-CoV-2 associated MIS-C with progressive respiratory failure and vasoplegic shock requiring extracorporeal support. At presentation, reverse transcription-polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 was negative, however, SARS-CoV2 antibody testing was positive. Multiple inflammatory markers and cardiac biomarkers were elevated. Echocardiogram demonstrated mildly depressed left ventricular function and no coronary anomalies noted. The patient required mechanical ventilation, vasopressors, and eventually extracorporeal membrane oxygenation (ECMO) for profound circulatory shock and progressive respiratory failure. During his clinical course, recovery of cardiac function was demonstrated however, a middle cerebral artery infarct and left frontal subarachnoid hemorrhage was suffered which ultimately the patient succumbed to. To the best of our knowledge, this is the youngest previously healthy child who had multi-system hyperinflammatory syndrome requiring ECMO support and the first case of SARS-CoV-2 related pediatric stroke.Clinical Trial Registration: None.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Infarction, Middle Cerebral Artery , SARS-CoV-2 , Subarachnoid Hemorrhage , Systemic Inflammatory Response Syndrome , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , Child, Preschool , Echocardiography , Fatal Outcome , Humans , Infarction, Middle Cerebral Artery/etiology , Infarction, Middle Cerebral Artery/physiopathology , Infarction, Middle Cerebral Artery/therapy , Male , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/physiopathology , Subarachnoid Hemorrhage/therapy , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/therapy
6.
J Stroke Cerebrovasc Dis ; 29(10): 105114, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-640910

ABSTRACT

BACKGROUND: Little is known about the effect of the Coronavirus disease 2019 pandemic on stroke care and the impact of the epidemic on acute stroke hospitalizations has not been described. METHODS: We analyze the stroke admission rate in three hospitals in New York City from January 1, 2020 through April 17, 2020, identifying all cases of acute ischemic stroke, intraparenchymal hemorrhage and subarachnoid hemorrhage. RESULTS: We confirmed 518 cases of out-of-hospital stroke. During the baseline period up to February 25, 2020, the daily stroke admission rate was stable, with the slope of the regression describing the number of admissions over time equal to -0.33 (se = 1.21), not significantly different from 0 (p = 0.79), with daily admissions averaging 41. During the pandemic period, the slope was -4.4 (se = 1.00); i.e., the number of stroke admissions decreased an average of 4.4 per week, (p = 0.005), with weekly admissions averaging 23, a reduction of 44% versus baseline. This general result was not different by patient age, sex, or race/ethnicity. CONCLUSIONS: The weekly stroke admission rate started declining two weeks prior to the local surge of coronavirus admissions. The consequences of lack of diagnosis and treatment of a large proportion of acute stroke patients are likely severe and lasting.


Subject(s)
Coronavirus Infections/therapy , Delivery of Health Care/trends , Intracranial Hemorrhages/therapy , Patient Admission/trends , Pneumonia, Viral/therapy , Stroke/therapy , Aged , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Female , Host Microbial Interactions , Humans , Intracranial Hemorrhages/diagnosis , Intracranial Hemorrhages/epidemiology , Intracranial Hemorrhages/virology , Male , Middle Aged , New York City/epidemiology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Prognosis , SARS-CoV-2 , Stroke/diagnosis , Stroke/epidemiology , Stroke/virology , Subarachnoid Hemorrhage/epidemiology , Subarachnoid Hemorrhage/therapy , Time Factors
7.
Stroke ; 51(8): 2315-2321, 2020 08.
Article in English | MEDLINE | ID: covidwho-596641

ABSTRACT

BACKGROUND AND PURPOSE: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, doctors and public authorities have demonstrated concern about the reduction in quality of care for other health conditions due to social restrictions and lack of resources. Using a population-based stroke registry, we investigated the impact of the onset of the COVID-19 pandemic in stroke admissions in Joinville, Brazil. METHODS: Patients admitted after the onset of COVID-19 restrictions in the city (defined as March 17, 2020) were compared with those admitted in 2019. We analyzed differences between stroke incidence, types, severity, reperfusion therapies, and time from stroke onset to admission. Statistical tests were also performed to compare the 30 days before and after COVID-19 to the same period in 2019. RESULTS: We observed a decrease in total stroke admissions from an average of 12.9/100 000 per month in 2019 to 8.3 after COVID-19 (P=0.0029). When compared with the same period in 2019, there was a 36.4% reduction in stroke admissions. There was no difference in admissions for severe stroke (National Institutes of Health Stroke Scale score >8), intraparenchymal hemorrhage, and subarachnoid hemorrhage. CONCLUSIONS: The onset of COVID-19 was correlated with a reduction in admissions for transient, mild, and moderate strokes. Given the need to prevent the worsening of symptoms and the occurrence of medical complications in these groups, a reorganization of the stroke-care networks is necessary to reduce collateral damage caused by COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Ischemic Attack, Transient/epidemiology , Pandemics , Patient Admission/statistics & numerical data , Pneumonia, Viral/epidemiology , Stroke/epidemiology , Adult , Aged , Aged, 80 and over , Brazil/epidemiology , COVID-19 , Female , Humans , Incidence , Intracranial Hemorrhages/epidemiology , Intracranial Hemorrhages/therapy , Ischemic Attack, Transient/therapy , Male , Middle Aged , Quality of Health Care , Reperfusion , Stroke/therapy , Subarachnoid Hemorrhage/epidemiology , Subarachnoid Hemorrhage/therapy
8.
J Stroke Cerebrovasc Dis ; 29(9): 105010, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-548353

ABSTRACT

Aneurysmal subarachnoid hemorrhage (SAH) patients require frequent neurological examinations, neuroradiographic diagnostic testing and lengthy intensive care unit stay. Previously established SAH treatment protocols are impractical to impossible to adhere to in the current COVID-19 crisis due to the need for infection containment and shortage of critical care resources, including personal protective equipment (PPE). Centers need to adopt modified protocols to optimize SAH care and outcomes during this crisis. In this opinion piece, we assembled a multidisciplinary, multicenter team to develop and propose a modified guidance algorithm that optimizes SAH care and workflow in the era of the COVID-19 pandemic. This guidance is to be adapted to the available resources of a local institution and does not replace clinical judgment when faced with an individual patient.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/therapy , Critical Pathways/organization & administration , Delivery of Health Care, Integrated/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Exposure/prevention & control , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/therapy , Subarachnoid Hemorrhage/therapy , Algorithms , COVID-19 , Clinical Protocols , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Coronavirus Infections/virology , Humans , Occupational Exposure/adverse effects , Occupational Health , Pandemics , Patient Safety , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Risk Factors , SARS-CoV-2 , Subarachnoid Hemorrhage/diagnosis , Virulence , Workflow
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