The Impact of the Pandemic on Acute Ischaemic Stroke Endovascular Treatment from a Multidisciplinary Perspective: A Nonsystematic Review

Background: At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reduced admissions for cerebrovascular events were identified, but acute ischaemic stroke (AIS) has remained one of the leading causes of death and disability for many years. The aim of this article is to review current literature data for multidisciplinary team (MDT) coordination, rational management of resources and facilities, ensuring timely medical care for large vessel occlusion (LVO) AIS patients requiring endovascular treatment during the pandemic. Methods: A detailed literature search was performed in Google Scholar and PubMed databases using these keywords and their combinations: acute ischaemic stroke, emergency, anaesthesia, airway management, mechanical thrombectomy, endovascular treatment, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19. Published studies and guidelines from inception to April 2021 were screened. The following nonsystematic review is based on a comprehensive literature search of available data, wherein 59 were chosen for detailed analysis. Results: The pandemic has an impact on every aspect of AIS care, including prethrombectomy, intraprocedural and post-thrombectomy issues. Main challenges include institutional preparedness, increased number of AIS patients with multiorgan involvement, different work coordination principles and considerations about preferred anaesthetic technique. Care of these patients is led by MDT and nonoperating room anaesthesia (NORA) principles are applied. Conclusions: Adequate management of AIS patients requiring mechanical thrombectomy during the pandemic is of paramount importance to maximise the benefit of the endovascular procedure. MDT work and familiarity with NORA principles decrease the negative impact of the disease on the clinical outcomes for AIS patients.

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Mechanical thrombectomy in acute ischaemic stroke patients with pre-interventional intracranial haemorrhage following intravenous thrombolysis

The Neuroradiology Journal ◽

10.1177/19714009211009112 ◽

2021 ◽

pp. 197140092110091

Author(s):

Hanna Styczen ◽

Matthias Gawlitza ◽

Nuran Abdullayev ◽

Alex Brehm ◽

Carmen Serna-Candel ◽

...

Keyword(s):

Clinical Outcome ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Intracranial Haemorrhage ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Modified Rankin Scale ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Vessel Occlusion

Background Data on outcome of endovascular treatment in patients with acute ischaemic stroke due to large vessel occlusion suffering from intravenous thrombolysis-associated intracranial haemorrhage prior to mechanical thrombectomy remain scarce. Addressing this subject, we report our multicentre experience. Methods A retrospective analysis of consecutive acute ischaemic stroke patients treated with mechanical thrombectomy due to large vessel occlusion despite the pre-interventional occurrence of intravenous thrombolysis-associated intracranial haemorrhage was performed at five tertiary care centres between January 2010–September 2020. Baseline demographics, aetiology of stroke and intracranial haemorrhage, angiographic outcome assessed by the Thrombolysis in Cerebral Infarction score and clinical outcome evaluated by the modified Rankin Scale at 90 days were recorded. Results In total, six patients were included in the study. Five individuals demonstrated cerebral intraparenchymal haemorrhage on pre-interventional imaging; in one patient additional subdural haematoma was observed and one patient suffered from isolated subarachnoid haemorrhage. All patients except one were treated by the ‘drip-and-ship’ paradigm. Successful reperfusion was achieved in 4/6 (67%) individuals. In 5/6 (83%) patients, the pre-interventional intracranial haemorrhage had aggravated in post-interventional computed tomography with space-occupying effect. Overall, five patients had died during the hospital stay. The clinical outcome of the survivor was modified Rankin Scale=4 at 90 days follow-up. Conclusion Mechanical thrombectomy in patients with intravenous thrombolysis-associated intracranial haemorrhage is technically feasible. The clinical outcome of this subgroup of stroke patients, however, appears to be devastating with high mortality and only carefully selected patients might benefit from endovascular treatment.

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Endovascular treatment for acute ischaemic stroke with large vessel occlusion: the experience of a regional stroke service

Clinical Radiology ◽

10.1016/j.crad.2015.08.007 ◽

2015 ◽

Vol 70 (12) ◽

pp. 1408-1413 ◽

Cited By ~ 9

Author(s):

M.W. McCusker ◽

S. Robinson ◽

S. Looby ◽

S. Power ◽

J.P. Ti ◽

...

Keyword(s):

Ischaemic Stroke ◽

Endovascular Treatment ◽

Acute Ischaemic Stroke ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Stroke Service

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O-007 Natural History of Acute Ischaemic Stroke from Large Vessel Occlusion Demonstrates Efficacy of Mechanical Thrombectomy: Preliminary Results of the Penumbra FIRST Study

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2013-010870.7 ◽

2013 ◽

Vol 5 (Suppl 2) ◽

pp. A4.2-A5 ◽

Cited By ~ 2

Author(s):

V Janardhan ◽

L Carlson ◽

R Gianatasio ◽

S Chen ◽

P Bhuva ◽

...

Keyword(s):

Natural History ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Preliminary Results ◽

History Of

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Acute ischaemic stroke interventions: large vessel occlusion and beyond

Stroke and Vascular Neurology ◽

10.1136/svn-2019-000262 ◽

2019 ◽

Vol 5 (1) ◽

pp. 80-85

Author(s):

Ahmad Sweid ◽

Batoul Hammoud ◽

Sunidhi Ramesh ◽

Daniella Wong ◽

Tyler D Alexander ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Therapy ◽

Comprehensive Overview ◽

Vessel Occlusion ◽

Management Techniques ◽

Randomised Controlled

Care for acute ischaemic stroke is one of the most rapidly evolving fields due to the robust outcomes achieved by mechanical thrombectomy. Large vessel occlusion (LVO) accounts for up to 38% of acute ischaemic stroke and comes with devastating outcomes for patients, families and society in the pre-intervention era. A paradigm shift and a breakthrough brought mechanical thrombectomy back into the spotlight for acute ischaemic stroke; this was because five randomised controlled trials from several countries concluded that mechanical thrombectomy for acute stroke offered overwhelming benefits. This review article will present a comprehensive overview of LVO management, techniques and devices used, and the future of stroke therapy. In addition, we review our institution experience of mechanical thrombectomy for posterior and distal circulation occlusion.

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ADAMTS-13 Activity Predicts Outcome in Acute Ischaemic Stroke Patients Undergoing Endovascular Treatment

Thrombosis and Haemostasis ◽

10.1055/s-0038-1637732 ◽

2018 ◽

Vol 47 (04) ◽

pp. 758-767 ◽

Cited By ~ 4

Author(s):

Meike Dirks ◽

Gerrit Grosse ◽

Matthias Böckmann ◽

Friedrich Goetz ◽

Thomas Pasedag ◽

...

Keyword(s):

Clinical Outcome ◽

Ischaemic Stroke ◽

Endovascular Treatment ◽

Acute Ischaemic Stroke ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Unfavourable Outcome ◽

Post Intervention ◽

Vessel Occlusion ◽

Mediators Of Inflammation

Background Endovascular treatment improves outcome in patients with acute ischaemic stroke due to large vessel occlusion in general. But outcome in some of these patients is jeopardized by recanalization failure or bleeding. Objectives This study aimed to determine a possible association of mediators of inflammation and haemostasis (C-reactive protein, interleukin-6, matrix metalloproteinase-9, monocyte chemoattractant protein-1, asymmetric dimethylarginine [ADMA], symmetric dimethylarginine, von Willebrand factor and a disintegrin and metalloproteinase with a thrombospondin type 1 motif 13 [ADAMTS-13]) with the post-intervention grade of reperfusion, complications and clinical outcome in patients who underwent endovascular treatment of ischaemic stroke. Patients/Methods Forty-one patients with acute ischaemic stroke due to large vessel occlusion were prospectively enrolled into the study. Peripheral venous blood was taken prior to treatment and 24 hours and 3, 7 and 90 days after symptom onset. The post-intervention grade of reperfusion was determined using the modified Treatment in Cerebral Infarction (mTICI) score. Clinical outcome on day 90 was assessed using the modified Rankin's scale (mRS). Results Low ADAMTS-13 activity (p = 0.009) and missing of statin therapy (p = 0.038) on admission were independently associated with unfavourable outcome (mRS: 5–6). Patients with unsuccessful reperfusion (mTICI: 0–1) showed higher ADMA levels on admission (p = 0.018). However, this association could not be confirmed in the binary logistic regression analysis. Conclusion Low ADAMTS-13 activity is a predictor of unfavourable outcome in patients with ischaemic stroke undergoing endovascular therapy. Further studies are warranted to elucidate the clinical and potential therapeutic role of ADAMTS-13 in acute ischaemic stroke.

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PND5 COST-EFFECTIVENESS OF MECHANICAL THROMBECTOMY USING SOLITAIRE STENT RETRIEVER IN COMBINATION WITH INTRAVENOUS TISSUE PLASMINOGEN ACTIVATOR (IV-TPA) VERSUS IV-TPA ALONE FOR THE TREATMENT OF ACUTE ISCHAEMIC STROKE DUE TO LARGE VESSEL OCCLUSION IN COLOMBIA

Value in Health Regional Issues ◽

10.1016/j.vhri.2019.08.335 ◽

2019 ◽

Vol 19 ◽

pp. S59

Author(s):

B. Pabon ◽

J. Tellez ◽

J. Arcos ◽

P. Guijarro

Keyword(s):

Cost Effectiveness ◽

Ischaemic Stroke ◽

Plasminogen Activator ◽

Acute Ischaemic Stroke ◽

Mechanical Thrombectomy ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Intravenous Tissue Plasminogen Activator ◽

Tissue Plasminogen ◽

Iv Tpa

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Acute Ischaemic Stroke Cooperation Group of Endovascular Treatment (ANGEL) registry: study protocol for a prospective, multicentre registry in China

Stroke and Vascular Neurology ◽

10.1136/svn-2018-000188 ◽

2019 ◽

Vol 4 (1) ◽

pp. 57-60 ◽

Cited By ~ 4

Author(s):

Xiaochuan Huo ◽

Ning Ma ◽

Dapeng Mo ◽

Feng Gao ◽

Ming Yang ◽

...

Keyword(s):

Ischaemic Stroke ◽

Endovascular Treatment ◽

Acute Ischaemic Stroke ◽

Treatment Algorithm ◽

Functional Independence ◽

Artery Occlusion ◽

Large Artery ◽

Vessel Occlusion ◽

Treatment Delivery ◽

Safety Endpoint

Background and purposeEndovascular treatment could improve functional outcomes and reduce mortality in patients with intracranial large artery occlusion. This registry aims to evaluate the endovascular treatment delivery and to improve endovascular treatment algorithm in clinical practice for patients with stroke in China.Methods and analysisThis multicentric, nationwide, prospective registry plans to include 20 stroke centres and recruit 900 consecutive AIS patients with large-artery occlusion under endovascular treatment. This registry will enrol acute large vessel occlusion patients suitable for endovascular treatment and the inclusion and exclusion criteria. In this study, 90 days functional independence (modified Rankin Scale score ≤2) is the primary efficacy endpoint. The procedural efficacy endpoint of this registry is target artery recanalisation defined by modified Thrombolysis in Cerebral Infarction score 2b or 3 after endovascular therapy. Symptomatic intracranial haemorrhage with 24±3 hours after the procedure is the primary safety endpoint of this registry.Ethics and disseminationBeijing Tiantan Hospital’s Ethics committee and all other participating centres approved the protocol and data collection of Acute Ischaemic Stroke Cooperation Group of Endovascular Treatment registry. Each participant or representative had a written informed consent.

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