Skip to main content

Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in COVID-19 pandemic: a systematic review

Abstract

Introduction

Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initially, COVID-19 is a disease that attacks the respiratory tract, but now the clinical manifestations of COVID-19 are various, including acute ischemic stroke (AIS). Emergency surgeries such as mechanical thrombectomy (MT) for AIS must be performed without any delay even during the COVID-19 pandemic, to reduce morbidity and mortality. Besides the focus on patient’s health, the safety of healthcare workers must also be considered. The aim of the study was to evaluate and summarize the scientific literature systematically to explore MT for AIS in the COVID-19 pandemic.

Data synthesis

The independent reviewers searched the literature through 12 electronic databases, searching for articles fulfilling inclusion and exclusion criteria. The data from all included studies were presented in a summary table featuring key points of each study. The authors independently assessed the risk of bias of 15 included articles.

Conclusion

Although MT procedure has been prolonged during the pandemic, clinical outcomes and procedure-related serious adverse events have remained unchanged during the COVID-19 pandemic. The screening process and the implementation of the PCS algorithm must be performed to reduce the spread of COVID-19 infection without threatening patient safety and clinical outcomes. The standard precaution of infection and the health assurance of healthcare workers and their families (including mental health) are also important factors that must be given special attention and consideration in the COVID-19 pandemic.

Introduction

Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1,2,3,4]. Phylogenetic analysis showed that SARS-CoV-2 had 79.5% and 51% similarity with severe acute respiratory coronavirus syndrome (SARS-CoV) and Middle East respiratory coronavirus syndrome (MERS-CoV) [2, 5]. The first case of COVID-19 occurred in December 2019 in Wuhan, Hubei Province, China with sources of transmission linked to the fish market and several wild animals (birds, snakes, and bats) in Wuhan [1, 6, 7]. SARS-CoV-2 can spread through direct contact (droplet and transmission between humans) and indirect contact (airborne transmission and contaminated objects) [2]. SARS-CoV-2 has spread widely in more than 250 countries, until 12 March 2020 COVID-19 was established as a global pandemic by the World Health Organization (WHO) with a world fatality rate of 5.28% [8,9,10,11]. Until June 20, 2020, there were 8,745,570 cases worldwide with a total of 461,760 deaths [9].

Initially, COVID-19 is a disease that attacks the respiratory tract with angiotensin-converting enzyme 2 (ACE2) as the main receptor, but now the clinical manifestations of COVID-19 are various, including neurological disorders. A neurological disorder that needs special attention because of their morbidity and mortality that can be suppressed if treated in the golden period is acute stroke [12,13,14,15,16,17,18]. The cytopathic effect of the virus and dysregulation of the immune system can cause severe inflammation, including inflammatory cytokine storms that cause COVID-19-associated coagulopathy (CAC) or thrombosis, and can cause acute ischemic stroke (AIS) [13]. SARS-CoV-2 has also been shown to be associated with thromboembolic disease and hypercoagulability state through mechanisms of hypoxia, inflammation, and disseminated intravascular coagulation (DIC) [19]. Inflammation, CAC, and endothelial dysfunction can also increase the permeability of the blood brain barrier, so that the virus can enter the central nervous system (CNS) through transcellular, paracellular, and retrograde transport of axons through the sensory and olfactory nerves (lamina cribiform and olfactory bulb) [13, 16, 20]. The incidence of COVID-19 patients with stroke in China and Europe was about 2.5% to 6% [13, 21]. The most common type of stroke is ischemic stroke (84.6%), followed by central venous thrombosis (7.7%), and hemorrhagic stroke (7.7%) [16, 22].

In the beginning, mechanical thrombectomy (MT) for AIS had not shown a better outcome in comparison with conventional medical treatments. But now with the better understanding and procedure of MT, MT is reported to have a clear advantage for AIS over conventional medical treatments [23,24,25]. Currently, MT has been widely accepted as the first-line therapy for patients with emergent large vessel occlusion (LVO) stroke [23, 26, 27]. During the COVID-19 pandemic, many operations have been postponed or even canceled due to the need for SARS-CoV-2 infection screening and relocation of limited medical resources. Even though, emergency surgeries such as MT for AIS must be performed without any delay even during the pandemic, to reduce morbidity and mortality [28, 29]. Besides the focus on patient’s health, the safety of healthcare workers must also be considered in the COVID-19 pandemic. Protected code stroke is a term used during the COVID-19 pandemic to prioritize acute assessment and management of AIS patients and to provide safety and protection of healthcare workers and also patients [30]. Expert consensuses from Chinese and European Federation recommended that all patients including those receiving MT should undergo screening process (preoperative chest CT scan and multidisciplinary consultations to exclude COVID-19) and the PCS algorithm [29,30,31,32].

MT for AIS in COVID-19 pandemic have been reported and explained in various studies, but there was no systematic review about it. The aim of the study was to evaluate and summarize the scientific literature systematically to explore MT for AIS in the COVID-19 pandemic.

Main text (review of the literature, results, discussion)

Review of literature

Inclusion and exclusion criteria

Inclusion criteria in this systematic review were publication type was full-text articles discussing MT for AIS in COVID-19 pandemic and primary studies of every design (descriptive study, such as case report and case series; observational study such as cross-sectional, case-control, and cohort; and experimental study such as clinical trial); the language of publication was English; time of publication was in December 2019–December 2020; and objective, methodology, and outcome measure must explain MT for AIS in the COVID-19 pandemic. Exclusion criteria in this systematic review was confounding variables were related to outcome in MT for AIS in the COVID-19 pandemic.

Literature search

This systematic review was conducted according to the Cochrane handbook for systematic reviews and the guideline of preferred reporting items for systematic review and meta-analysis (PRISMA) [33, 34]. A systematic search literature was used in these electronic databases: Cambridge Core, Clinical Key, Ebsco, Emerald Insight, JSTOR, Medline, Nature, Proquest, PubMed, Science Direct, Scopus, and Springer Link. The search was conducted using the following keywords for title and abstract: (thrombectomy OR mechanical thrombectomy) AND (stroke OR ischemic stroke) AND (COVID-19 OR coronavirus OR SARS-CoV-2). The reference lists from retrieved literature were also examined to avoid missing any published data.

Data collection and analysis

Studies were selected for evaluation after two independent reviewers (AK and DT) had collected titles and abstracts identified in the electronic database. The results of the two independent reviewers were compared by a third independent reviewer (YA), and any differences of opinion were resolved by discussion. Full papers from potential studies were independently assessed by the investigators (R and RA). All studies selected for this systematic review were screened by two reviewers independently to validate the results (AK and JB). The data from all retrieved studies were presented in a summary table featuring key points of each study. The key points of each study were: first author, country, and year; study design; sample; outcome measure; and result.

Quality assessment

The lead author independently assessed quality assessment and risk of bias of each included study and discussed them with other authors. Quality assessment and risk of bias within studies were assessed using criteria developed by Hawker and colleagues 35, 36]. Ratings were concluded (very poor, poor, fair, good, and not applicable) across nine different categories: abstract and title; introduction and aim; method and data; sampling; data analysis; ethic and bias; result; generalisability; and implication and usefulness. The risk of bias potentially affecting the cumulative evidence across studies was determined by examining study methods, ethics committee approvals, study funding, and conflicts of interest [35, 36]. Newcastle–Ottawa scale for cohort study was also used to assess the methodological quality of prospective study; interpretation of total score was ≥ 7 points were included in good studies, 5–6 points were included in fair studies, < 5 points were included in poor studies. Newcastle-Ottawa scale adapted for cross-sectional study was used to assess the methodological quality of the cross-sectional study. Interpretation of total score was 9 to 10 points were considered in very good studies, 7 to 8 points were considered in good studies, 5 to 6 points were considered in satisfactory studies, and 0 to 4 points were considered in unsatisfactory studies [37,38,39,40,41]. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to assess the methodological quality of the case report and case series [42,43,44].

Results

Selection of articles for review

Figure 1 summarized the identified, screened, and included articles for review. Initially, 288 peer-reviewed articles were identified from electronic databases and an additional 5 articles were identified through other sources (search engine). After removing duplicates, 168 articles remained for the title and abstract screening. Articles that did not meet the inclusion and exclusion criteria were not further screened. Eighteen articles were screened for eligibility of which 15 articles met all the inclusion criteria.

Fig. 1
figure1

PRISMA flow diagram

Assessment of study validity (quality assessment and risk of bias)

All eligible studies were associated with MT for AIS in the COVID-19 pandemic. Table 1 provided quality assessment and risk of bias by Hawker and colleagues, and all of the studies are fair and good. Table 2 provided quality scores for cohort study and the study got 7 points that were considered in good study. Table 3 provided quality scores for cross-sectional study and all of the studies got 5–8 points that were considered satisfactory and good studies. Tables 4 and 5 showed JBI critical appraisal checklist for case report and case series; all of the studies had overall appraisal in “included studies” for systematic review.

Table 1 Quality assessment and risk of bias by Hawker and colleagues
Table 2 Newcastle-Ottawa scale (cohort study)
Table 3 Newcastle-Ottawa scale adapted for cross-sectional study
Table 4 JBI Critical Appraisal Checklist for case report
Table 5 JBI Critical Appraisal Checklist for case series

Study characteristic

The study characteristics for the included studies could be seen in Table 5. There were one cohort study, eight cross-sectional studies, three case series studies, and one case report. The studies reported about patient characteristics (baseline characteristic, clinical presentation, laboratory examination, and radiology examination), MT procedure, clinical outcome, the care delays, and PCS of AIS in the COVID-19 pandemic (Table 6).

Table 6 Study characteristic

Discussion

MT for AIS in COVID-19 pandemic

There are some guidelines related to MT for AIS in the COVID-19 pandemic but there is no systematic review about it. The differences about MT for AIS in COVID-19 pandemic and non-pandemic are about patient characteristics (baseline characteristic, clinical presentation, laboratory examination, and radiology examination), MT procedure, clinical outcome, the care delays, and PCS. The differences in patient characteristics were not discussed in this systematic review because they were more related to stroke in COVID-19 generally. All of the AIS types were LVO because MT was frequently used in LVO case [23, 26, 27].

Kerleroux and colleagues (2020) reported about 21% decrease in MT cases in the first month of the COVID-19 pandemic in French [28]. Kwan and colleagues (2020) reported a decrease of 21% in MT procedure from the external referral hospital in UK [49]. McConachie and colleagues (2020) reported about 27.7% decrease of MT procedure in April 2020 compared with the first 3 months of 2020 in the UK [51]. Qureshi and colleagues (2020) reported significant reduction of MT procedure in the USA [57]. The most possible reason was the strict guidelines of stroke care centers to perform MT in eligible patients. Patients with indications outside of strict guidelines may have not been accepted for MT [28, 49]. Other plausible reasons were an increase in healthy lifestyles during the COVID-19 pandemic (reduced the incidence of stroke), the strict PCS and screening procedure, or it could be due to the patient's reluctance to come to the hospital/emergency room (especially in “mild” symptoms of stroke) for fear of being exposed to the COVID-19. It is important to explain and educate the public that this is not a problem because the hospital has taken standard precautions to ensure that patients and medical personnel are protected and the hospital remains the best and safe place to provide appropriate treatment for emergency cases such as AIS care. Hospital administration must also ensure patient safety through appropriate standard precautions and the use of personal protective equipment (PPE) [10, 58]. PCS is the modified of regular code stroke during the COVID-19 pandemic to provide an additional layer of protection (including PPE) for patients and medical personnel who were engaged in triage, rapid assessment, COVID-19 screening, and treatment of patients [30]. Cox and colleagues (2020), Mansour and colleagues (2020), Yaeger and colleagues (2020), and Yeboah and colleagues (2020) and reported about the importance of healthcare worker to follow PCS algorithm and the use of appropriate PPE to reduce the risk of COVID-19 infection [46, 50, 55, 56].

Pop and colleagues (2020) reported that there were 39.6% reduction of stroke alerts and 27.6% decrease in MT procedure [52]. Yang and colleagues (2020) reported about the prolonged door to puncture time (by 48.5 min, p: 0.002) and door to reperfusion time (by 41 min, p: 0.047) [29]. Kerleroux and colleagues (2020) reported the delays between imaging to groin time (by 29 min, p < 0.001) [28]. Tiedt and colleagues (2020) reported about the longer of door to puncture time in patients (47 min vs. 38 min, p: 0.005) [53]. The plausible reasons were the saturation of health medical resources as a result of the COVID-19 pandemic; screening process and the extra standard and isolation precautions applied in PCS; social distancing of each individual; and also the fear of medical worker’s, patient’s, or family’s fear of COVID-19 contamination risk at the hospital [28, 29, 52, 53]. In some research, these care delays did not impact the short-term outcomes. Although there was no significant difference to short-term outcome (follow up with the national institutes of health stroke scale/NIHSS in day 1–3 after MT), there were not long-term follow-up (such as 90 days of the modified rankin scale/mRS) to evaluate the long-term efficacy [28, 29, 49, 50].

MT technique used in COVID-19 pandemic is various related to the operator (direct aspiration first-pass technique/ADAPT, stent retrieval, or stent-aspiration combination/solumbra technique) [29]. In Wang A and colleagues (2020), the operator used solumbra technique [29]. Solumbra technique is safe technique and increases the rate of successful reperfusion [24, 29]. The difficulties of the MT process in COVID-19 pandemic were re-occlusion of the vessel soon after reperfusion (related to systemic hypercoagulability, microvascular thrombo-inflammation, and endotheliitis), low rate of fragmentation, and distal embolization (due to clot composition of reddish clot-suggestive high red blood cell content and neutrophil extracellular traps) [19, 47]. Yang and colleagues (2020) reported about the reduction of puncture to reperfusion time (from 40.5 to 32 min) without the effect of patient safety and successful reperfusion rates during the COVID-19 pandemic. A series of ways were performed to reduce the time of the MT procedure, including performing the entire procedure by an experienced neurointerventional specialist and reducing angiography processes based on good CT angiography images. Other possible reasons were the use of local anesthesia and first-line ADAPT strategy [29]. Sedation and anesthesia choice for MT in COVID-19 pandemic present its own challenges and limited published data are available at this time to guide appropriate decisions and conclusions. Al Kasab and colleagues (2020) reported that general anesthesia was associated with poor functional outcome and mortality in COVID-19 patients [45]. General anesthesia with intubation carries the appeal of a closed respiratory circuit and the load of viral particles in the environment is decreased. However, bag-mask ventilation and intubation itself are highly aerosol-generating procedures. The negative pressure of environment and room, the minimum number of staff with full PPE, and the use of video laryngoscopy can be used to reduce the risk of COVID-19 infection. The use of conscious sedation when possible (such as sufficient oxygenation) avoids this intense aerosolization. The appropriate MT technique and anesthesia choice is still being debated and further research is needed [19, 29, 49, 50, 59, 60].

Clinical outcomes in patients with stroke and COVID-19 who undergo MT are various in some studies. Escalard and colleagues (2020) and Wang and colleagues (2020) reported about the poor clinical outcome; otherwise, Mansour and colleagues (2020), Yaeger and colleagues (2020), Yang and colleagues (2020), and Yeboah and colleagues (2020) reported about the good clinical outcome; while Kwan and colleagues (2020) and Tiedt and colleagues (2020) reported about the similar clinical outcome in pre-COVID-19 vs. COVID-19 periods [19, 29, 47, 50, 55, 56]. The difference in patient characteristics affected on this difference and need further research with similar characteristics on the global scale. Havenon and colleagues (2020) reported an increased risk of death in patients who undergo MT with comorbid COVID-19 [48]. The systemic complication (including acute respiratory failure, acute renal failure, and coagulopathy), and the delay of diagnosis and treatment in COVID-19 patient were the likely explanation of it [13, 19, 48].

Strength and limitation of the study

This systematic review involved studies that reported 15 studies related to MT for AIS in the COVID-19 pandemic. Most of the studies were analytical observational studies (eight) studies and the majority of the studies discussed the comparison of MT in AIS patients before and during the COVID-19 pandemic.

The limitation of the study was the variance of the demography, limited follow-up time, confounding variable in each study (there were confounding variables that cannot be controlled in human subjects), and also the limitation of study type (only an observational study, and the cohort study was only one).

Future implication

The current systematic review can be a scientific reading, material, and consideration to physician, researcher, and all of the readers related to MT for AIS in the COVID-19 pandemic. Further research is needed for the selection of appropriate MT technique and anesthesia choice, and also the evaluation of long-term follow-up related to MT for AIS in the COVID-19 pandemic.

Conclusion

Although MT procedure has been prolonged during the pandemic, clinical outcomes and procedure-related serious adverse events have remained unchanged during the COVID-19 pandemic. The screening process and the implementation of the PCS algorithm must be performed to reduce the spread of COVID-19 infection without threatening patient safety and clinical outcomes. The standard precaution of infection and the health assurance of healthcare workers and their families (including mental health) are also important factors that must be given special attention and consideration in the COVID-19 pandemic.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Abbreviations

95% CI:

95% confidence interval

ACE2:

Angiotensin-converting enzyme 2

AIS:

Acute ischemic stroke

CAC:

COVID-19 associated coagulopathy

CNS:

Central nervous system

COVID-19:

Coronavirus disease 2019

GA:

General anesthesia

IQR:

Interquartile range

LVO:

Large vessel occlusion

min:

Minutes

MERS-CoV:

Middle East respiratory coronavirus syndrome

MT:

Mechanical thrombectomy

NIHSS:

The National Institutes of Health Stroke Scale

OR:

Odds ratio

p:

Probability

PCS:

Protected code stroke

PPE:

Personal protective equipment

PRISMA:

Preferred reporting items for systematic review and meta-analysis

r:

Correlation coefficient (correlation test)

RR:

Relative risk

SARS-CoV:

Severe acute respiratory syndrome coronavirus

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

References

  1. 1.

    Li H, Liu SM, Yu XH, Tang SL, Tang CK. Coronavirus disease 2019 (COVID-19): current status and future perspectives. Int J Antimicrob Agents. 2020;55(5):1–8.

    CAS  Article  Google Scholar 

  2. 2.

    Lotfi M, Hamblin MR, Rezaei N. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin Chim Acta. 2020;508:254–66. https://doi.org/10.1016/j.cca.2020.05.044.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: origin, transmission, and characteristics of human coronaviruses. J Adv Res. 2020;24:91–8. https://doi.org/10.1016/j.jare.2020.03.005.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  4. 4.

    Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: a review. Clin Immunol. 2020;215:1–7.

    Article  Google Scholar 

  5. 5.

    Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33. https://doi.org/10.1056/NEJMoa2001017.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  6. 6.

    Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109:1–4.

    Article  Google Scholar 

  7. 7.

    Fu B, Chen Y. The 2019 novel coronavirus disease with secondary ischemic stroke: two cases report; 2019. p. 1–12.

    Google Scholar 

  8. 8.

    Avula A, Nalleballe K, Narula N, Sapozhnikov S, Dandu V, Toom S, et al. COVID-19 presenting as stroke. Brain Behav Immun. 2020;87:115–9. https://doi.org/10.1016/j.bbi.2020.04.077.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  9. 9.

    WHO. Coronavirus disease 2019 (COVID-19) Situation report. Geneva: WHO; 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports.

  10. 10.

    Zhao J, Rudd A, Liu R. Challenges and potential solutions of stroke care during the coronavirus disease 2019 (COVID-19) outbreak. Stroke. 2020;51(5):1356–7. https://doi.org/10.1161/STROKEAHA.120.029701.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    Li X, Geng M, Peng Y, Meng L, Lu S. Molecular immune pathogenesis and diagnosis of COVID-19. J Pharm Anal. 2020;10(2):102–8. https://doi.org/10.1016/j.jpha.2020.03.001.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  12. 12.

    Baig AM. Neurological manifestations in COVID-19 caused by SARS-CoV-2. CNS Neurosci Ther. 2020;26(5):499–501. https://doi.org/10.1111/cns.13372.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  13. 13.

    Divani AA, Andalib S, Di Napoli M, Lattanzi S, Hussain MS, Biller J, et al. Coronavirus disease 2019 and stroke: clinical manifestations and pathophysiological insights. J Stroke Cerebrovasc Dis. 2020;29(8):1–12.

    Article  Google Scholar 

  14. 14.

    Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683–90. https://doi.org/10.1001/jamaneurol.2020.1127.

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K. Neurological manifestations of COVID-19 and other coronavirus infections: a systematic review. Clin Neurol Neurosurg. 2020;194:1–7.

    Article  Google Scholar 

  16. 16.

    Pinzon RT, Wijaya VO, Buana RB, Al Jody A, Nunsio PN. Neurologic characteristics in coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Front Neurol. 2020;11:1–11.

    Article  Google Scholar 

  17. 17.

    Wang HY, Li XL, Yan ZR, Sun XP, Han J, Zhang BW. Potential neurological symptoms of COVID-19. Ther Adv Neurol Disord. 2020;13:1–2.

    Google Scholar 

  18. 18.

    Whittaker A, Anson M, Harky A. Neurological manifestations of COVID-19: a systematic review and current update. Acta Neurol Scand. 2020;142(1):14–22. https://doi.org/10.1111/ane.13266.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  19. 19.

    Wang A, Mandigo GK, Yim PD, Meyers PM, Lavine SD. Stroke and mechanical thrombectomy in patients with COVID-19: Technical observations and patient characteristics. J Neurointerv Surg. 2020;12(7):648–53. https://doi.org/10.1136/neurintsurg-2020-016220.

    PubMed  Article  Google Scholar 

  20. 20.

    Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM. Neurologic alterations due to respiratory virus infections. Front Cell Neurosci. 2018;12:1–15.

    Article  Google Scholar 

  21. 21.

    Hassett C, Gedansky A, Mays M, Uchino K. Acute ischemic stroke and COVID-19. Cleve Clin J Med. 2020:19–21. https://doi.org/10.3949/ccjm.87a.ccc042.

  22. 22.

    Li Y, Li M, Wang M, Zhou Y, Chang J, Xian Y, Wang D, Mao L, Jin H, Hu B. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol. 2020;5(3):279–84. https://doi.org/10.1136/svn-2020-000431.

  23. 23.

    Zhao W, Ma P, Zhang P, Yue X. Mechanical thrombectomy for acute ischemic stroke in octogenarians: a systematic review and meta-analysis. Front Neurol. 2020;10:1–8.

    CAS  Google Scholar 

  24. 24.

    Munich SA, Vakharia K, Levy EI. Overview of mechanical thrombectomy techniques. Neurosurgery. 2019;85(1):S60–7. https://doi.org/10.1093/neuros/nyz071.

    PubMed  Article  Google Scholar 

  25. 25.

    Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke. Stroke. 2019;50:344–418.

    Article  Google Scholar 

  26. 26.

    Goyal N, Tsivgoulis G, Malhotra K, Ishfaq MF, Pandhi A, Frohler MT, et al. Medical management vs mechanical thrombectomy for mild strokes: an international multicenter study and systematic review and meta-analysis. JAMA Neurol. 2019;77(1):16–24.

    PubMed Central  Article  Google Scholar 

  27. 27.

    Lambrinos A, Schaink AK, Dhalla I, Krings T, Casaubon LK, Sikich N, et al. Mechanical thrombectomy in acute ischemic Stroke: a systematic review. Can J Neurol Sci. 2016;43(4):455–60. https://doi.org/10.1017/cjn.2016.30.

    PubMed  PubMed Central  Article  Google Scholar 

  28. 28.

    Kerleroux B, Fabacher T, Bricout N, Moïse M, Testud B, Vingadassalom S, et al. Mechanical thrombectomy for acute ischemic stroke amid the COVID-19 outbreak. Stroke. 2020;51(7):2012–7. https://doi.org/10.1161/STROKEAHA.120.030373.

    CAS  PubMed  Article  Google Scholar 

  29. 29.

    Yang B, Wang T, Chen J, Chen Y, Wang Y, Gao P, et al. Impact of the COVID-19 pandemic on the process and outcome of thrombectomy for acute ischemic stroke. J Neurointerv Surg. 2020;12(7):664–8. https://doi.org/10.1136/neurintsurg-2020-016177.

    PubMed  Article  Google Scholar 

  30. 30.

    Khosravani H, Rajendram P, Notario L, Chapman MG, Menon BK. Protected code stroke: hyperacute stroke management during the coronavirus disease 2019 (COVID-19) Pandemic. Stroke. 2020;51(6):1891–5. https://doi.org/10.1161/STROKEAHA.120.029838.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  31. 31.

    Aggour M, White P, Kulcsar Z, Fiehler J, Brouwer P. European Society of minimally invasive neurological therapy (ESMINT) recommendations for optimal interventional neurovascular management in the COVID-19 era. J Neurointerv Surg. 2020;12(6):542–4. https://doi.org/10.1136/neurintsurg-2020-016137.

    PubMed  Article  Google Scholar 

  32. 32.

    He Y, Hong T, Wang M, Jiao L, Ge Y, Haacke EM, et al. Prevention and control of COVID-19 in neurointerventional surgery: Expert consensus from the Chinese Federation of Interventional and Therapeutic Neuroradiology (CFITN) and the International Society for Neurovascular Disease (ISNVD). J Neurointerv Surg. 2020;12(7):658–63. https://doi.org/10.1136/neurintsurg-2020-016073.

    PubMed  PubMed Central  Article  Google Scholar 

  33. 33.

    Higgins J, Green S. Cochrane handbook for systematic reviews of intervention 5.2. United Kingdom: Wiley; 2017. p. 1–50.

    Google Scholar 

  34. 34.

    Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):1–6.

    Article  Google Scholar 

  35. 35.

    Clay-Williams R, Ludlow K, Testa L, Li Z, Braithwaite J. Medical leadership, a systematic narrative review: do hospitals and healthcare organisations perform better when led by doctors? BMJ Open. 2017;7(9):e014474.

    PubMed  PubMed Central  Article  Google Scholar 

  36. 36.

    Hawker S, Payne S, Kerr C, Hardey M, Powell J. Appraising the evidence: reviewing disparate data systematically. Qual Health Res. 2002;12(9):1284–99. https://doi.org/10.1177/1049732302238251.

    PubMed  Article  Google Scholar 

  37. 37.

    Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The newcastle-ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2019.

    Google Scholar 

  38. 38.

    Herzog R, Álvarez-pasquin MJ, Díaz C, Luis J, Barrio D, Estrada JM, et al. Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health. 2013;13:154.

    PubMed  PubMed Central  Article  Google Scholar 

  39. 39.

    Viswanathan M, Ansari MT, Berkman ND, Chang S, Hartling L, McPheeters M, et al. Methods guide for effectiveness and comparative effectiveness reviews, assessing the risk of bias of individual studies in systematic reviews of health care interventions. USA: AHRQ Publication; 2008.

    Google Scholar 

  40. 40.

    Islam M, Iqbal U, Walther B, Atique S, Dubey N, Nguyen P, et al. Benzodiazepine use and risk of dementia in the elderly population: a systematic review and meta-analysis. Neuroepidemiology. 2016;47(3-4):181–91. https://doi.org/10.1159/000454881.

    PubMed  Article  Google Scholar 

  41. 41.

    Luchini C, Stubbs B, Solmi M, Veronese N. Assessing the quality of studies in meta-analyses: advantages and limitations of the newcastle ottawa scale. World J Meta-Anal. 2017;5(4):80–4. https://doi.org/10.13105/wjma.v5.i4.80.

    Article  Google Scholar 

  42. 42.

    Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Mil Med Res. 2020;7(1):1–11.

    Google Scholar 

  43. 43.

    JBI. Checklist for case reports: The Joanna Briggs Institute; 2017. p. 1–5. Available from: http://joannabriggs.org/assets/docs/critical-appraisal-tools/JBI_Critical_Appraisal-Checklist_for_Case_Reports2017.pdf. Accessed 1 July 2020.

  44. 44.

    JBI. Checklist for case series: The Joanna Briggs Institute; 2017. p. 1–6. Available from: https://joannabriggs.org/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Case_Control_Studies2017_0.pdf. Accessed 1 July 2020.

  45. 45.

    Al Kasab S, Almallouhi E, Alawieh A, Levitt MR, Jabbour P, Sweid A, et al. International experience of mechanical thrombectomy during the COVID-19 pandemic: Insights from STAR and ENRG. J Neurointerv Surg. 2020;12(11):1039–44. https://doi.org/10.1136/neurintsurg-2020-016671.

    PubMed  Article  Google Scholar 

  46. 46.

    Cox M, Ramchand P, McCabe M, Hoey C, Lehmann J, Collinson R, et al. Neuroendovascular treatment of acute stroke during COVID-19: a guide from the frontlines. J Radiol Nurs. 2020;39(3):168–73. https://doi.org/10.1016/j.jradnu.2020.05.007.

    PubMed  PubMed Central  Article  Google Scholar 

  47. 47.

    Escalard S, Maiër B, Redjem H, Delvoye F, Hébert S, Smajda S, et al. Treatment of acute ischemic stroke due to large vessel occlusion with COVID-19: experience from Paris. Stroke. 2020;51(8):2540–3. https://doi.org/10.1161/STROKEAHA.120.030574.

    CAS  PubMed  Article  Google Scholar 

  48. 48.

    Havenon A d, Yaghi S, Mistry EA, Delic A, Hohmann S, Shippey E, et al. Endovascular thrombectomy in acute ischemic stroke patients with COVID-19: prevalence, demographics, and outcomes. J Neurointerv Surg. 2020;12(11):1045–8. https://doi.org/10.1136/neurintsurg-2020-016777.

    PubMed  Article  Google Scholar 

  49. 49.

    Kwan J, Brown M, Bentley P, Brown Z, D'Anna L, Hall C, et al. Impact of COVID-19 Pandemic on a Regional Stroke Thrombectomy Service in the United Kingdom. Cerebrovasc Dis. 2021;50(2):178–184. https://doi.org/10.1159/000512603.

  50. 50.

    Mansour OY, Malik AM, Linfante I. Mechanical thrombectomy of COVID-19 positive acute ischemic stroke patient: a case report and call for preparedness. BMC Neurol. 2020;20(1):358. https://doi.org/10.1186/s12883-020-01930-x.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  51. 51.

    McConachie D, McConachie N, White P, Crossley R, Izzath W. Mechanical thrombectomy for acute ischaemic stroke during the COVID-19 pandemic: changes to UK practice and lessons learned. Clin Radiol. 2020;75(10):795.e7–795.e13. https://doi.org/10.1016/j.crad.2020.07.001.

  52. 52.

    Pop R, Quenardelle V, Hasiu A, Mihoc D, Sellal F, Dugay MH, et al. Impact of the COVID-19 outbreak on acute stroke pathways - insights from the Alsace region in France. Eur J Neurol. 2020;27(9):1783–7. https://doi.org/10.1111/ene.14316.

  53. 53.

    Tiedt S, Bode FJ, Uphaus T, Alegiani A, Gröschel K, Petzold GC. Impact of the COVID-19-pandemic on thrombectomy services in Germany. Neurol Res Pr. 2020;2(44):1–6.

    Google Scholar 

  54. 54.

    Qureshi A, Siddiq F, French B, Gomez C, Jani V, Hassan A, et al. Effect of COVID-19 Pandemic on mechanical thrombectomy for acute ischemic stroke treatment in United States. J Stroke Cerebrovasc Dis. 2020;29(10):1–3.

    Article  Google Scholar 

  55. 55.

    Yaeger KA, Fifi JT, Lara-Reyna J, Rossitto C, Ladner T, Yim B, et al. Initial Stroke Thrombectomy Experience in New York City during the COVID-19 Pandemic. AJNR Am J Neuroradiol. 2020;41(8):1357–60. https://doi.org/10.3174/ajnr.A6652.

  56. 56.

    Yeboah K, Edgell R, Conway J, Alshekhlee A. Interventional Stroke Management in a Patient With COVID-19. Neurol Clin Pract. 2021;11(2):e199–e201. https://doi.org/10.1212/CPJ.0000000000000884.

  57. 57.

    Qureshi AI, Abd-allah F, Al-senani F, Aytac E, Borhani-haghighi A, Ciccone A, et al. Management of acute ischemic stroke in patients with COVID-19 infection: insights from an international panel. Am J Emerg Med. 2020;38:1548.e5–7.

    Article  Google Scholar 

  58. 58.

    Fiehler J, Brouwer P, Díaz C, Hirsch JA, Kulcsar Z, Liebeskind D, et al. COVID-19 and neurointerventional service worldwide: a survey of the European Society of Minimally Invasive Neurological Therapy (ESMINT), the Society of NeuroInterventional Surgery (SNIS), the Sociedad Iberolatinoamericana de Neuroradiologia Diagnostica y. J Neurointerv Surg. 2020;0:1–5.

    Google Scholar 

  59. 59.

    Leslie-Mazwi TM, Fargen KM, Levitt M, Derdeyn CP, Feske SK, Patel AB, et al. Preserving Access: A Review of Stroke Thrombectomy during the COVID-19 Pandemic. AJNR Am J Neuroradiol. 2020;41(7):1136–41. https://doi.org/10.3174/ajnr.A6606.

  60. 60.

    Salahuddin H, Castonguay AC, Zaidi SF, Burgess R, Jadhav AP, Jumaa MA. Interventional stroke care in the era of COVID-19. Front Neurol. 2020;11(468):1–8.

    Google Scholar 

Download references

Acknowledgements

None.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Affiliations

Authors

Contributions

AK and DT conceived the original idea and collected data; YA collected data and proof outline; R, RA, and JB wrote the manuscript with the support of other authors. All authors have read and approved the final manuscript to be published.

Corresponding author

Correspondence to Aditya Kurnianto.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kurnianto, A., Tugasworo, D., Andhitara, Y. et al. Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in COVID-19 pandemic: a systematic review. Egypt J Neurol Psychiatry Neurosurg 57, 67 (2021). https://doi.org/10.1186/s41983-021-00321-4

Download citation

Keywords

  • Acute ischemic stroke
  • COVID-19
  • Ischemic stroke
  • Mechanical thrombectomy