Brain and Heart Crosstalk During Neurointerventional Procedures: The Role of the Trigeminocardiac Reflex: An Updated Systematic Review.

The trigeminocardiac reflex is a well-described brainstem reflex that clinically manifests as bradycardia, hypotension, or apnea. This physiological phenomenon is extensively reported during open neurosurgical procedures, but very few data exist for trigeminocardiac reflex occurrence during neurointerventional procedures. This systematic review aims to provide aggregated information related to the trigeminocardiac reflex during neurointerventional procedures and to improve understanding of the various mechanisms that can incite this unique brain-heart crosstalk.

Management of Acute Ischemic Stroke in the Interventional Neuroradiology Suite During the COVID-19 Pandemic: A Global Survey.

BACKGROUND: According to early reports, patients affected by coronavirus disease 2019 (COVID-19) are at an increased risk of developing cerebrovascular events, including acute ischemic stroke (AIS). The COVID-19 pandemic may also impose difficulties in managing AIS patients undergoing endovascular thrombectomy (EVT), as well as concerns for the safety of health care providers. This international global survey aims to gather and summarize information from tertiary care stroke centers on periprocedural pathways and endovascular management of AIS patients during the COVID-19 pandemic. METHODS: A cross-sectional survey-based research questionnaire was sent to 259 tertiary care stroke centers with neurointerventional facilities worldwide. RESULTS: We received 114 responses (response rate: 44%) from 25 different countries across all 5 continents. The number of AIS patients and EVT cases were reported to have decreased during the pandemic. Most participants reported conducting COVID-19 testing before (49%) or after the procedure (31%); 20% of centers did not test at all. Only 16% of participating centers reported using a negative pressure room for the thrombectomy procedure. Strikingly, 50% of participating centers reported no changes in the anesthetic management of AIS patients undergoing EVT during the pandemic. CONCLUSIONS: This global survey provides information on the challenges in managing AIS patients undergoing EVT during the COVID-19 pandemic. Its findings can be used to improve patient outcomes and the safety of the health care team worldwide.