RESUMEN
Aneurysmal subarachnoid hemorrhage (SAH) patients require frequent neurological examinations, neuroradiographic diagnostic testing and lengthy intensive care unit stay. Previously established SAH treatment protocols are impractical to impossible to adhere to in the current COVID-19 crisis due to the need for infection containment and shortage of critical care resources, including personal protective equipment (PPE). Centers need to adopt modified protocols to optimize SAH care and outcomes during this crisis. In this opinion piece, we assembled a multidisciplinary, multicenter team to develop and propose a modified guidance algorithm that optimizes SAH care and workflow in the era of the COVID-19 pandemic. This guidance is to be adapted to the available resources of a local institution and does not replace clinical judgment when faced with an individual patient.
Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/terapia , Vías Clínicas/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Exposición Profesional/prevención & control , Equipo de Protección Personal/provisión & distribución , Neumonía Viral/terapia , Hemorragia Subaracnoidea/terapia , Algoritmos , COVID-19 , Protocolos Clínicos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Humanos , Exposición Profesional/efectos adversos , Salud Laboral , Pandemias , Seguridad del Paciente , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Neumonía Viral/virología , Factores de Riesgo , SARS-CoV-2 , Hemorragia Subaracnoidea/diagnóstico , Virulencia , Flujo de TrabajoAsunto(s)
Corteza Cerebral/patología , Venas Cerebrales/patología , Oxigenoterapia Hiperbárica/métodos , Anciano , Atrofia , Imagen de Difusión por Resonancia Magnética , Embolia Aérea/diagnóstico , Embolia Aérea/patología , Embolia Aérea/terapia , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND PURPOSE: We evaluated recanalization rates, clinical outcomes, and safety when manual aspiration thrombectomy is used in conjunction with other thrombolytic modalities in a consecutive case series of patients with large vessel intracranial occlusion. METHODS: We conducted a retrospective review of a prospectively acquired acute endovascular stroke database. Manual aspiration thrombectomy was carried out with Distal Access and Penumbra reperfusion catheters of different sizes placed in the thrombus and aspirated with a syringe. RESULTS: We identified 191 patients: Occlusion locations were as follows: M1% to 50%, M2% to 10%, internal carotid artery terminus 25%, and vertebrobasilar 15%. Median treatment duration was 90 minutes. Recanalization results were Thrombolysis in Myocardial Ischemia 2/3 93%, Thrombolysis in Myocardial Ischemia 3 27%, Thrombolysis In Cerebral Infarction 2a/2b/3 91%, Thrombolysis In Cerebral Infarction 2b/3 71%, and Thrombolysis In Cerebral Infarction 3 25%. Larger catheters were associated with higher recanalization rates. Parenchymal hematoma rate was 13.6%. The favorable outcome (90-day modified Rankin Scale ≤ 2) rate was 54%. Mortality at 90 days was 25%. CONCLUSIONS: Manual aspiration thrombectomy is a useful addition to the armamentarium of endovascular treatment modalities for acute stroke.