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Letter regarding ‘Neurointervention for emergent large vessel occlusion strokes during the COVID-19 pandemic’
  1. Anahid Hamidianjahromi1,
  2. Ashkan Mowla2
  1. 1 Department of Neurology, Jahrom University of Medical Sciences, Jahrom, Iran (the Islamic Republic of)
  2. 2 Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA
  1. Correspondence to Dr Ashkan Mowla, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA; mowla_a{at}

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We read with great interest the recent article by Fiorella et al 1 in which the authors discussed several practical points on neurointerventional management of large vessel occlusion (LVO) acute ischemic stroke (AIS) during the coronavirus 2019 (COVID-19) pandemic. Although we fully agree with Fiorella et al about considering aggressive measures in triaging during the endovascular treatment (EVT) of AIS patients in order to minimize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exposure and transmission to healthcare personnel (HCP), we are urging a more cautious and balanced approach.

While EVT is one of the most effective treatment in the management of LVO strokes, its impact is optimized if it is performed in a timely manner.2 It has been speculated that every 30-min delay from symptom onset to reperfusion (OTR) of the occluded vessel translates into a decrease in good functional outcome by 12%–21%.3 4 OTR time constitutes a combination of onset of stroke symptom to groin/arm puncture (OTP) and puncture-to-recanalization times. Ota et al 5 have demonstrated the independent impact of OTP time on the functional outcomes of the patients undergoing …

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  • Contributors All authors contributed to the theoretical formalism, designing the study, data collection, data analysis and writing the manuscript.

  • 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.

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

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