Efficacy and safety of recanalization therapy for acute ischemic stroke with large vessel occlusion: A systematic review

Useless research, they don't tell us the definition of effective.  I'm sure it is not 100% recovery. 

Efficacy and safety of recanalization therapy for acute ischemic stroke with large vessel occlusion: A systematic review

Hui W, Wu C, Zha W, et al Stroke|June 23, 2020 A systematic review was conducted to analyze the efficacy and safety of recanalization therapy for acute ischemic stroke with large vessel occlusion. Researchers carried out to search PubMed, Embase, the Cochrane Central Register of Controlled Trials, and SinoMed, and a search was performed for clinical trials on ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and StrokeCenter.org. The study selection, data abstraction, and quality assessments were conducted by four independent reviewers. This study enrolled 17 trials including a total of 3,236 in and 8 ongoing clinical trials. The results showed that IVT+MT appears to be the most effective strategy, without increasing detrimental effects, for thrombolysis-eligible patients with large vessel occlusion acute ischemic stroke in comparison with other recanalization treatments. Future trials and real-world studies are warranted and should use unified definitions of symptomatic intracranial hemorrhage and recanalization to improve the current evidentiary basis for recanalization treatment. Read the full article on Stroke.

Cerebral ischemic and hemorrhagic complications of coronavirus disease 2019

You did not do timely intervention, I'm sure you didn't start anti-coagulation therapies IMMEDIATELY upon diagnosis of COVID-19, you waited until the LVO had already occurred. And you falsely think reperfusion is the correct endpoint. I'm going to demand anti-coagulation IMMEDIATELY UPON DIAGNOSIS, I don't care what the fuck my doctor thinks. I'm not going to die just because clinical results haven't been published.  You obviously can't listen to me, I'm not medically trained. 

This statement from research is why I'm so adamant about this:

The autopsies of lungs showed lots of alveolar(lungs) capillary microthrombi were 9 times as prevalent in patients with Covid-19 as in patients with influenza.

Cerebral ischemic and hemorrhagic complications of coronavirus disease 2019

Ahmad Sweid1, Batoul Hammoud2, Kimon Bekelis3, Symeon Missios3, Stavropoula I Tjoumakaris1, Michael R Gooch1, Nabeel A Herial1, Hekmat Zarzour1, Victor Romo4, Maureen DePrince1, Robert H Rosenwasser1 and Pascal Jabbour1

Abstract 

Background: 
The coronavirus disease 2019 is associated with neurological manifestations including stroke.
Objectives: 
We present a case series of coronavirus disease 2019 patients from two institutions with acute cerebrovascular pathologies. In addition, we present a pooled analysis of published data on large vessel occlusion in the setting of coronavirus disease 2019 and a concise summary of the pathophysiology of acute cerebrovascular disease in the setting of coronavirus disease 2019.
Methods: A retrospective study across two institutions was conducted between 20 March 2020 and 20 May 2020, for patients developing acute cerebrovascular disease and diagnosed with coronavirus disease 2019. We performed a literature review using the PubMed search engine.
Results: 
The total sample size was 22 patients. The mean age was 59.5 years, and 12 patients were female. The cerebrovascular pathologies were 17 cases of acute ischemic stroke, 3 cases of aneurysm rupture, and 2 cases of sinus thrombosis. Of the stroke and sinus thrombosis patients, the mean National Institute of Health Stroke Scale was 13.8 8.0, and 16 (84.2%) patients underwent a mechanical thrombectomy procedure. A favorable thrombolysis in cerebral infarction score was achieved in all patients. Of the 16 patients that underwent a mechanical thrombectomy, the mortality incidence was five (31.3%). Of all patients (22), three (13.6%) patients developed hemorrhagic conversion requiring decompressive surgery. Eleven (50%) patients had a poor functional status (modified Rankin Score 3–6) at discharge, and the total mortality incidence was eight (36.4%).
Conclusions: 
Despite timely intervention and favorable reperfusion, the mortality rate in coronavirus disease 2019 patients with large vessel occlusion was high in our series and in the pooled analysis. Notable features were younger age group, involvement of both the arterial and venous vasculature, multivessel involvement, and complicated procedures due to the clot consistency and burden.

Field Assessment Stroke Triage for Emergency Destination

I can't find the  FAST-ED tool so you will just have to take their word for it that it is good. It is your brain that is dying. Wouldn't the same have to be done for large hemorrhagic strokes also?
http://stroke.ahajournals.org/content/47/8/1997.abstract?etoc

A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes

1. Fabricio O. Lima, MD, MPH, PhD;
2. Gisele S. Silva, MD, MPH, PhD;
3. Karen L. Furie, MD, MPH;
4. Michael R. Frankel, MD;
5. Michael H. Lev, MD;
6. Érica C.S. Camargo, MD, PhD, MSc;
7. Diogo C. Haussen, MD;
8. Aneesh B. Singhal, MD;
9. Walter J. Koroshetz, MD;
10. Wade S. Smith, MD;
11. Raul G. Nogueira, MD

+ Author Affiliations

1. From the Centro de Ciências da Saúde, Curso de Medicina, Universidade de Fortaleza, Fortaleza-CE, Brazil (F.O.L.); Neurovascular Service, Department of Neurology, Federal University of São Paulo, São Paulo-SP, Brazil (G.S.S.); Department of Neurology, Brown University, Providence, RI (K.L.F.); Neuroendovascular and Neurocritical Care Services, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (M.R.F., D.C.H., R.G.N.); Department of Radiology (M.H.L.) and Stroke Service, Department of Neurology (É.C.S.C., A.B.S.), Massachusetts General Hospital, Boston; National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD (W.J.K.); and UCSF Neurovascular Service, Department of Neurology, University of California San Francisco (W.S.S.).

1. Correspondence to Raul G. Nogueira, MD, 49 Jesse Hill Dr, SE Room No. 333, Atlanta, GA 30303. E-mail raul.g.nogueira@emory.edu

Abstract

Background and Purpose—Patients with large vessel occlusion strokes (LVOS) may be better served by direct transfer to endovascular capable centers avoiding hazardous delays between primary and comprehensive stroke centers. However, accurate stroke field triage remains challenging. We aimed to develop a simple field scale to identify LVOS.

Methods—The Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale was based on items of the National Institutes of Health Stroke Scale (NIHSS) with higher predictive value for LVOS and tested in the Screening Technology and Outcomes Project in Stroke (STOPStroke) cohort, in which patients underwent computed tomographic angiography within the first 24 hours of stroke onset. LVOS were defined by total occlusions involving the intracranial internal carotid artery, middle cerebral artery-M1, middle cerebral artery-2, or basilar arteries. Patients with partial, bihemispheric, and anterior+posterior circulation occlusions were excluded. Receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value of FAST-ED were compared with the NIHSS, Rapid Arterial Occlusion Evaluation (RACE) scale, and Cincinnati Prehospital Stroke Severity (CPSS) scale.

Results—LVO was detected in 240 of the 727 qualifying patients (33%). FAST-ED had comparable accuracy to predict LVO to the NIHSS and higher accuracy than RACE and CPSS (area under the receiver operating characteristic curve: FAST-ED=0.81 as reference; NIHSS=0.80, P=0.28; RACE=0.77, P=0.02; and CPSS=0.75, P=0.002). A FAST-ED ≥4 had sensitivity of 0.60, specificity of 0.89, positive predictive value of 0.72, and negative predictive value of 0.82 versus RACE ≥5 of 0.55, 0.87, 0.68, and 0.79, and CPSS ≥2 of 0.56, 0.85, 0.65, and 0.78, respectively.

Conclusions—FAST-ED is a simple scale that if successfully validated in the field, it may be used by medical emergency professionals to identify LVOS in the prehospital setting enabling rapid triage of patients.