Stroke-Risk, COVID-19 and When to Seek Emergency Care
In This Article
- "Patients should know that even at the height of the pandemic there is emergency treatment readily available, and they must not delay at home due to fear of COVID-19 exposure at the hospital," says Thabele Leslie-Mazwi, MD
- Massachusetts General Hospital is taking every precaution to ensure patients are protected as they arrive at the emergency department
- Access to stroke treatment is a regional priority that ensures maintained care during the COVID-19 pandemic
- Current research is actively investigating the links between SARS-CoV-2 infection and stroke
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As the number of COVID-19 cases has increased, there has been a decrease in the number of patients seeking medical care due, in part, to fears of infection. Neurologists cite concerns surrounding the dip in stroke patients seeking care, fearing they may deliberately be putting off the critical care they need in an effort to avoid COVID-19 exposure.
"Patients should know that even at the height of the pandemic there is emergency treatment readily available, and they must not delay at home due to fear of COVID-19 exposure at the hospital," says Thabele Leslie-Mazwi, MD, director of Endovascular Stroke Services and specialist in Neuroendovascular and Neurocritical Care at the Massachusetts General Hospital Department of Neurology and Department of Neurosurgery. "We prospectively prepared months ago for handling COVID-19 positive and negative stroke patients during the pandemic and have experienced swift and smooth care logistics because of this preparation."
Mass General has pioneered a series of innovative stroke programs to expedite patient transfer once received by the hospital. For example, the LVO2OR program allows patients with outside scans to directly transfer into the neuroendovascular suite when patients arrive. These programs have continued through all changes brought by COVID-19.
Another member of the team, Neurosurgeon Christopher Stapleton, MD, is leading an investigation into the nature of stroke in the setting of COVID-19, using regional data.
Institutional Changes and Regional Partnerships
Stroke care requires a multifaceted team with coordinated input from the Department of Neurology, Department of Neurosurgery, Division of Neuroradiology, the Department of Emergency Medicine, the Department of Surgery and various other critical aspects of the hospital. In collaboration with Joshua A. Hirsch, MD, vice chair of procedural services and service line chief of NeuroInterventional Radiology, Dr. Leslie-Mazwi and his team have published on the experience of preserving access to care for stroke patients.
"There are additional steps for providers of care that are necessary to ensure the protection of patients and staff—such as when and how we use personal protective equipment and adaptations of imaging protocols," says Aman Patel, MD, director of Cerebrovascular and Endovascular Neurosurgery at Mass General.
He continues, "There are a variety of other modifications that affect the entire chain of stroke care. I think patients will be incredibly impressed to see just how much has gone into all our planning."
In addition to institutional changes, Mass General coordinated through the Massachusetts Comprehensive Stroke Center Collaborative, which is a partnership with the American Stroke Association, with neighboring states to prioritize stroke services.
"Fortunately, we organized with other regional hospitals, including in neighboring states, so that if a single center was overwhelmed by COVID-19 admissions, we had a centralized process for diverting the critical stroke patient to the closest center with capacity," says Dr. Patel.
The established infrastructure will continue with a resurgence of the disease or a future pandemic, providing a more resilient system of stroke care.
Tenuous Links Between Blood Clots, COVID-19 and Stroke
Providing optimal patient care amidst the COVID-19 pandemic requires identifying the specific effects of SARS-CoV-2 on stroke. Although there is a clear link between COVID-19 and blood clotting, which can lead to stroke, a direct connection to stroke is lacking. As such, it is important to obtain the best data possible to ensure an accurate picture of the impact of COVID-19 on stroke.
"SARS-CoV-2 is a disease that we are gradually beginning to understand," says Dr. Leslie-Mazwi. "It clearly affects more than just the lungs. One concern is the impact of the infection on blood clotting. These patients appear to clot more easily and therefore are at risk of diseases related to blood clots, such as deep venous thrombosis and pulmonary embolism. Whether this is true for stroke remains to be clarified."
Recent reports in the New England Journal of Medicine have noted an increase in the number of cases of stroke in those younger than 50 years of age in isolated U.S. COVID-19 epicenters, but further investigation is required.
"The nature of stroke in the setting of COVID-19 is a question we are actively investigating," says Dr. Leslie-Mazwi. "Caution is necessary because the published literature is very limited and sample sizes are small. Such associations were not seen in the available data from China and Italy and other epicenters. In our region, which is a U.S. epicenter, there has not been a predominance of young patients with stroke presentations."
While a direct relationship between COVID-19 and stroke is still unfolding, it is imperative that patients understand that stroke care is a priority at Mass General and remains available at all times during the pandemic.
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