TY - JOUR
T1 - Stroke Care during the COVID-19 Pandemic
T2 - International Expert Panel Review
AU - Venketasubramanian, Narayanaswamy
AU - Anderson, Craig
AU - Ay, Hakan
AU - Aybek, Selma
AU - Brinjikji, Waleed
AU - de Freitas, Gabriel R.
AU - Del Brutto, Oscar H.
AU - Fassbender, Klaus
AU - Fujimura, Miki
AU - Goldstein, Larry B.
AU - Haberl, Roman L.
AU - Hankey, Graeme J.
AU - Heiss, Wolf Dieter
AU - Henriques, Isabel Lestro
AU - Kase, Carlos S.
AU - Kim, Jong S.
AU - Koga, Masatoshi
AU - Kokubo, Yoshihiro
AU - Kuroda, Satoshi
AU - Lee, Kiwon
AU - Lee, Tsong Hai
AU - Liebeskind, David S.
AU - Lip, Gregory Y.H.
AU - Meairs, Stephen
AU - Medvedev, Roman
AU - Mehndiratta, Man Mohan
AU - Mohr, Jay P.
AU - Nagayama, Masao
AU - Pantoni, Leonardo
AU - Papanagiotou, Panagiotis
AU - Parrilla, I. Guillermo
AU - Pastori, Daniele
AU - Pendlebury, Sarah T.
AU - Pettigrew, Luther Creed
AU - Renjen, Pushpendra N.
AU - Rundek, Tatjana
AU - Schminke, Ulf
AU - Shinohara, Yukito
AU - Tang, Wai Kwong
AU - Toyoda, Kazunori
AU - Wartenberg, Katja E.
AU - Wasay, Mohammad
AU - Hennerici, Michael G.
N1 - Publisher Copyright:
© 2021 S. Karger AG, Basel. Copyright: All rights reserved.
PY - 2021/5
Y1 - 2021/5
N2 - Background: Coronavirus disease 2019 (COVID-19) has placed a tremendous strain on healthcare services. This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new setting: modifications needed for prehospital emergency rescue and hyperacute care; inpatient intensive or stroke units; posthospitalization rehabilitation; follow-up including at-risk family and community; and multispecialty departmental developments in the allied professions. Summary: The severe acute respiratory syndrome coronavirus 2 uses spike proteins binding to tissue angiotensin-converting enzyme (ACE)-2 receptors, most often through the respiratory system by virus inhalation and thence to other susceptible organ systems, leading to COVID-19. Clinicians facing the many etiologies for stroke have been sobered by the unusual incidence of combined etiologies and presentations, prominent among them are vasculitis, cardiomyopathy, hypercoagulable state, and endothelial dysfunction. International standards of acute stroke management remain in force, but COVID-19 adds the burdens of personal protections for the patient, rescue, and hospital staff and for some even into the postdischarge phase. For pending COVID-19 determination and also for those shown to be COVID-19 affected, strict infection control is needed at all times to reduce spread of infection and to protect healthcare staff, using the wealth of well-described methods. For COVID-19 patients with stroke, thrombolysis and thrombectomy should be continued, and the usual early management of hypertension applies, save that recent work suggests continuing ACE inhibitors and ARBs. Prothrombotic states, some acute and severe, encourage prophylactic LMWH unless bleeding risk is high. COVID-19-related cardiomyopathy adds risk of cardioembolic stroke, where heparin or warfarin may be preferable, with experience accumulating with DOACs. As ever, arteritis can prove a difficult diagnosis, especially if not obvious on the acute angiogram done for clot extraction. This field is under rapid development and may generate management recommendations which are as yet unsettled, even undiscovered. Beyond the acute management phase, COVID-19-related stroke also forces rehabilitation services to use protective precautions. As with all stroke patients, health workers should be aware of symptoms of depression, anxiety, insomnia, and/or distress developing in their patients and caregivers. Postdischarge outpatient care currently includes continued secondary prevention measures. Although hoping a COVID-19 stroke patient can be considered cured of the virus, those concerned for contact safety can take comfort in the increasing use of telemedicine, which is itself a growing source of patient-physician contacts. Many online resources are available to patients and physicians. Like prior challenges, stroke care teams will also overcome this one. Key Messages: Evidence-based stroke management should continue to be provided throughout the patient care journey, while strict infection control measures are enforced.
AB - Background: Coronavirus disease 2019 (COVID-19) has placed a tremendous strain on healthcare services. This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new setting: modifications needed for prehospital emergency rescue and hyperacute care; inpatient intensive or stroke units; posthospitalization rehabilitation; follow-up including at-risk family and community; and multispecialty departmental developments in the allied professions. Summary: The severe acute respiratory syndrome coronavirus 2 uses spike proteins binding to tissue angiotensin-converting enzyme (ACE)-2 receptors, most often through the respiratory system by virus inhalation and thence to other susceptible organ systems, leading to COVID-19. Clinicians facing the many etiologies for stroke have been sobered by the unusual incidence of combined etiologies and presentations, prominent among them are vasculitis, cardiomyopathy, hypercoagulable state, and endothelial dysfunction. International standards of acute stroke management remain in force, but COVID-19 adds the burdens of personal protections for the patient, rescue, and hospital staff and for some even into the postdischarge phase. For pending COVID-19 determination and also for those shown to be COVID-19 affected, strict infection control is needed at all times to reduce spread of infection and to protect healthcare staff, using the wealth of well-described methods. For COVID-19 patients with stroke, thrombolysis and thrombectomy should be continued, and the usual early management of hypertension applies, save that recent work suggests continuing ACE inhibitors and ARBs. Prothrombotic states, some acute and severe, encourage prophylactic LMWH unless bleeding risk is high. COVID-19-related cardiomyopathy adds risk of cardioembolic stroke, where heparin or warfarin may be preferable, with experience accumulating with DOACs. As ever, arteritis can prove a difficult diagnosis, especially if not obvious on the acute angiogram done for clot extraction. This field is under rapid development and may generate management recommendations which are as yet unsettled, even undiscovered. Beyond the acute management phase, COVID-19-related stroke also forces rehabilitation services to use protective precautions. As with all stroke patients, health workers should be aware of symptoms of depression, anxiety, insomnia, and/or distress developing in their patients and caregivers. Postdischarge outpatient care currently includes continued secondary prevention measures. Although hoping a COVID-19 stroke patient can be considered cured of the virus, those concerned for contact safety can take comfort in the increasing use of telemedicine, which is itself a growing source of patient-physician contacts. Many online resources are available to patients and physicians. Like prior challenges, stroke care teams will also overcome this one. Key Messages: Evidence-based stroke management should continue to be provided throughout the patient care journey, while strict infection control measures are enforced.
KW - Coronavirus disease 2019
KW - Management
KW - Review
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85103375622&partnerID=8YFLogxK
U2 - 10.1159/000514155
DO - 10.1159/000514155
M3 - 文献综述
C2 - 33756459
AN - SCOPUS:85103375622
SN - 1015-9770
VL - 50
SP - 245
EP - 261
JO - Cerebrovascular Diseases
JF - Cerebrovascular Diseases
IS - 3
ER -