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Society of NeuroInterventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of COVID-19
  1. Justin F Fraser1,
  2. Adam S Arthur2,3,
  3. Michael Chen4,
  4. Michael Levitt5,
  5. J Mocco6,
  6. Felipe C Albuquerque7,
  7. Sameer A Ansari8,
  8. Guilherme Dabus9,
  9. Mahesh V Jayaraman10,
  10. William J Mack11,
  11. James Milburn12,
  12. Maxim Mokin13,
  13. Sandra Narayanan14,
  14. Ajit S Puri15,
  15. Adnan H Siddiqui16,17,
  16. Jenny P Tsai18,
  17. Richard P Klucznik19
  1. 1 Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
  2. 2 Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  3. 3 Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  4. 4 Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
  5. 5 Departments of Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington School of Medicine, Seattle, Washington, USA
  6. 6 Neurosurgery, The Mount Sinai Health System, New York, New York, USA
  7. 7 Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  8. 8 Departments of Radiology, Neurology, and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  9. 9 Interventional Neuroradiology and Neuroendovascularl Surgery, Miami Cardiac & Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
  10. 10 Diagnostic Imaging, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  11. 11 Neurosurgery, University of Southern California, Los Angeles, California, USA
  12. 12 Radiology, Ochsner Medical System, New Orleans, Louisiana, USA
  13. 13 Neurosurgery, University of South Florida, Tampa, Florida, USA
  14. 14 Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  15. 15 Radiology and Neurosurgery, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
  16. 16 Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
  17. 17 Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
  18. 18 Neurology, Spectrum Health, Grand Rapids, Michigan, USA
  19. 19 Radiology, Houston Methodist Hospital, Houston, Texas, USA
  1. Correspondence to Dr Justin F Fraser, Neurological Surgery, University of Kentucky, Lexington, KY 40506, USA; Jfr235{at}uky.edu

https://doi.org/10.1136/neurintsurg-2020-016098

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    Introduction

    The global pandemic of coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), represents an unprecedented challenge to our healthcare system.1 As the number of identified COVID-19 patients exponentially increases, protocols for the safe delivery of care of both patients and providers are vital. This is especially true, given the number of healthcare providers who have contracted the disease. If we fail to protect physicians, nursing staff, and ancillary providers, we will fail to meet the needs of future patients. The successful care of future COVID-19 patients will depend on effective safety and prevention strategies for healthcare workers.2

    Patients with acute ischemic stroke (AIS) are a high-risk patient cohort. Li et al performed an analysis of six studies encompassing 1527 patients with COVID-19 and showed that patients with cardio/cerebrovascular disease comprised 16.4% of the cohort, but that the incidence was approximately threefold higher among patients with severe COVID-19 requiring intensive care (ICU) admission.3 Thus, patients with a history of AIS and/or its risk factors are particularly at risk for the severe form of COVID-19. Additionally, there is early evidence that SARS-CoV-2 can cause neurologic signs, and that it has been reported in the brains of both patients and animal models.4 Of patients with SARS-CoV-2 respiratory distress, 36.4% had neurologic symptoms with 4.5% of severe patients suffering ischemic stroke.5 In this setting, neurointerventionalists should expect to be involved in the care of COVID-19-positive patients, as well as those whose status is unknown and those at risk of a severe form of the disease.

    While the data on COVID-19 are rapidly emerging, the Society of NeuroInterventional Surgery seeks to provide neurointerventionalists with rapid up-to-date recommendations on the management of stroke thrombectomy in this setting with an emphasis on safety measures for …

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    Footnotes

    • Twitter @AdamArthurMD, @dr_mchen, @docroc99

    • Contributors This was a collaborative statement from the SNIS Board of Directors. The primary author, JFF, constructed the manuscript text, but solicited input from all other contributors equally, and modified the document using consensus to ensure agreement. All authors reviewed the document and provided relevant and vital feedback for modification.

    • 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.

    • Disclaimer These recommendations for the treatment of neurointerventional patients during the COVID-19 pandemic are provided for informational and educational purposes only. Adherence to these recommendations will not ensure successful treatment in every situation. Furthermore, these recommendations should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the medical condition. These recommendations reflect the best available information at this time. The results of future studies may require revisions to these recommendations. SNIS does not warrant the accuracy or completeness of these recommendations and assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of these recommendations or for any errors or omissions.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data availability statement There are no data in this work.