Deans' stroke musings: Stroke With COVID-19? Check the Large Vessels

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, August 1, 2020

Stroke With COVID-19? Check the Large Vessels

Useless. This is determining after the fact, the stroke has already occurred. WHAT THE FUCK IS NEEDED TO PREVENT SUCH STROKES? As soon as you are diagnosed with COVID-19 we need a protocol to prevent these clot complications and strokes. WHAT IS IT?

Stroke With COVID-19? Check the Large Vessels

Observational study suggests distinct difference in presentation

by Crystal Phend, Senior Editor, MedPage Today July 31, 2020

A computer rendering of the human brain with a light radiating from the center of it representing a stroke over coronaviruses

COVID-19's excess stroke risk appeared to be largely related to large vessel strokes, an observational study showed.
Among stroke code patients at one large health system in New York City during the pandemic surge there, 38.3% had COVID-19 (126 of 329 seen from March 16 to April 30, 2020).
Large vessel occlusion (LVO) as a cause of the stroke was 2.4-fold more common with COVID-19 than without it after adjustment for race and ethnicity (P=0.011), Shingo Kihira, MD, of Icahn School of Medicine at Mount Sinai in New York City, and colleagues reported in the American Journal of Roentgenology.
Of the stroke cases, 31.7% of those in COVID-19 patients were LVOs compared with 15.3% in those without COVID-19 (P=0.001). But there was not much difference between groups for small vessel occlusions (SVOs), at 15.9% and 13.8%, respectively (P=0.632).
"Physicians should lower their threshold of suspicion for large vessel stroke in patients with COVID-19 who present with acute neurologic symptoms," the researchers concluded, recommending prompt workup.
"Health care providers in the emergency department and inpatient areas should be cognizant of this association and not delay activating a stroke code," they wrote.
Notably, the most common location for the LVO strokes was middle cerebral artery segments M1 and M2 (62.0% [44 of 71 cases]), which are potentially candidates for mechanical thrombectomy.
"This association may aid neurointerventionalists assessing the presence and location of an LVO if they are aware of this elevated risk in the COVID-19 population," Kihira's group pointed out.
Also, for LVOs seen during the COVID-19 pandemic, it might be worth taking extra personal protective equipment and infection control precautions for patients who have not been tested for SARS-CoV-2 infection or are waiting for results, they added.
All patients with LVO are already currently treated as possibly having COVID until infection is ruled out, commented Larry B. Goldstein, MD, of the University of Kentucky in Lexington, although only one at his center has yet tested positive "despite unchanged high volumes of patients with LVO having thrombectomy since the beginning of the pandemic."
The American Heart Association/American Stroke Association have urged physicians to follow standard guidelines for stroke care during the pandemic when possible in terms of patient selection for therapy, treatment times, and monitoring after recanalization.
However, its temporary guidance noted that "in the setting of the pandemic full compliance has become a goal, not an expectation" and pointed to things that may help in the face of shortages in staff, personal protective equipment, and medical equipment.
One notable difference in care for LVO patients found to be SARS-CoV-2 positive is that they should have a more extensive evaluation for abnormal clotting, Goldstein said.
Strokes and coagulopathy have been noted with COVID-19, although the researchers said they couldn't determine causality for the link between LVO and the virus with their retrospective observational study.
Why LVO might be more common than SVO with COVID-19 isn't clear, but it's an area of active investigation, Kihira told MedPage Today.
The retrospective study included all 329 patients for whom a code for stroke was activated (53% men, mean age 67) out of the total 9,814 patients (5,862 with COVID-19) during the study period at the Mount Sinai system's six hospitals. Among these patients, 35.3% had acute ischemic stroke confirmed with imaging; 21.6% (71) had LVO; and 14.6% (48) had SVO.
The only stroke-related predictor of COVID-19-positive status was Hispanic ethnicity. This group accounted for 38.1% of patients with COVID-19 versus 20.7% of those without (P=0.001).