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Editor’s column
Neurointervention for emergent large vessel occlusion during the COVID-19 pandemic
  1. David Fiorella1,2,
  2. Kyle M Fargen3,
  3. Thabele M Leslie-Mazwi4,
  4. Michael Levitt5,
  5. Stephen Probst6,
  6. Sergio Bergese7,
  7. Joshua A Hirsch8,
  8. Felipe C Albuquerque9
  1. 1 Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
  2. 2 Department of Radiology, Stony Brook University, Stony Brook, New York, USA
  3. 3 Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
  4. 4 Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5 University of Washington School of Medicine, Seattle, Washington, USA
  6. 6 Anesthesiology, Stony Brook University, Stony Brook, New York, USA
  7. 7 Department of Anesthesia, Stony Brook University, Stony Brook, New York, USA
  8. 8 NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  9. 9 Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  1. Correspondence to Dr Felipe C Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA; Felipe.Albuquerque{at}barrowbrainandspine.com

https://doi.org/10.1136/neurintsurg-2020-016117

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    Background

    Introduced into the human population in December 2019, the zoonotic novel β-coronavirus spread rapidly. Labeled Coronavirus Disease 2019 (COVID-19) by the World Health Organization (WHO), the infection reached pandemic proportions by March 11, 2020. At the time of writing this commentary, globally our way of life is transforming. Hospitals are no exception, with mobilization into an emergency mode including halting all non-urgent elective procedures and clinic visits.

    The Centers for Disease Control and Prevention (CDC) and the WHO are currently recommending aggressive measures to prevent viral transmission. For healthcare workers, aside from standard precautions like using personal protective equipment (PPE) and handwashing, these bodies are strongly encouraging the practice of ‘social distancing’ (SD) and ‘self-quarantine’ (SQ) for those with suspected or proven infections. In essence, SD means avoiding crowds, closing schools, canceling all social events and meetings, and maintaining a 6-foot distance between individuals. SQ refers to isolating oneself for 2 weeks without any social contact to avoid transmission. These efforts will be critical to mitigating COVID-19 spread, as they may ‘flatten the curve’ of new and serious cases and prevent the healthcare system from being overwhelmed.

    Healthcare workers are on the front line, and doctors, nurses, and hospital staff are at highest risk of contracting the virus. As cases become ubiquitous throughout the healthcare system, many staff will become secondarily infected and will require medical treatment and SQ. As the volume of infected personnel increases, many services will need to operate on a skeleton crew. If infection breaches a critical threshold, some emergency services may cease to be possible. The greatest potential impact will be on mechanical thrombectomy (MT) in acute ischemic stroke.

    Covid-19 in acute ischemic stroke

    MT for emergent large vessel occlusion (ELVO) represents one of the most impactful and effective emergent interventions in medicine,1 markedly reducing morbidity and mortality. MT is …

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    Footnotes

    • Twitter @JoshuaAHirsch

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

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