A Case of Endovascular Treatment for In-Hospital Stroke with COVID-19 under Protected Code Stroke

Takahiro Osada; Rie Aoki; Hideyuki Hanano; Takashi Yasuda; Masaaki Imai; Yumetaro Sakakibara; Sachiko Kurokawa; Yuka Chin; Kentaro Tokuoka; Fumio Sakamaki; Shinri Oda; Masami Shimoda; Shigeru Nogawa

doi:10.5797/jnet.cr.2020-0134

CASE REPORTS

A Case of Endovascular Treatment for In-Hospital Stroke with COVID-19 under Protected Code Stroke

Takahiro Osada, Rie Aoki, Hideyuki Hanano, Takashi Yasuda, Masaaki Imai, Yumetaro Sakakibara, Sachiko Kurokawa, Yuka Chin, Kentaro Tokuoka, Fumio Sakamaki, Shinri Oda, Masami Shimoda, Shigeru Nogawa

Author information

Takahiro Osada
Department of Neurosurgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
Rie Aoki
Department of Neurosurgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
Hideyuki Hanano
Department of Neurology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
Takashi Yasuda
Department of Neurology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
Masaaki Imai
Department of Neurosurgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
Yumetaro Sakakibara
Department of Neurosurgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
Sachiko Kurokawa
Department of Neurology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
Yuka Chin
Department of Neurology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
Kentaro Tokuoka
Department of Neurology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
Fumio Sakamaki
Department of Respiratory Medicine, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
Shinri Oda
Department of Neurosurgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
Masami Shimoda
Department of Neurosurgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
Shigeru Nogawa
Department of Neurology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan

Keywords: in-hospital stroke, COVID-19, protected code stroke, mechanical thrombectomy, coagulopathy

JOURNAL OPEN ACCESS

2021 Volume 15 Issue 4 Pages 246-253

DOI https://doi.org/10.5797/jnet.cr.2020-0134

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Abstract

Objective: Coronavirus disease 2019 (COVID-19) is characterized by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and presents with respiratory symptoms. Overall, 5.7% of COVID-19 patients with severe respiratory status have been reported to develop acute cerebrovascular diseases (CVDs), and 41.3% of COVID-19 cases were considered nosocomial infections. Therefore, Protected Code Stroke, which is a guideline for acute stroke management that takes into account the safety of healthcare workers, has been developed. We created an operational manual for COVID-19 in the endovascular treatment center of our hospital and report our experience treating acute stroke in a COVID-19 patient.

Case Presentation: A 67-year-old man presented with a 5-day history of fever. Chest CT showed ground glass opacity (GGO) on admission, and the polymerase chain reaction (PCR) test for COVID-19 was positive. Dysarthria, right-sided hemiparesis, and aphasia were discovered on the morning of the third day after hospitalization. MRI showed an acute ischemic stroke at the left corona radiata and occlusion of the left middle cerebral artery (MCA). Progression of right-sided hemiparesis and exacerbation of respiratory status developed after the MRI. Tracheal intubation was performed, and the patient was treated with intravenous alteplase and mechanical thrombectomy (MT). Recanalization of blood flow was not obtained, and the neurological deficits remained.

Conclusion: MT was performed for large-vessel occlusion (LVO) in a COVID-19 patient during the COVID-19 pandemic. Safety for healthcare workers and appropriate rapid treatment for acute stroke patients are both vital in the current environment.

Corresponding author

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