By Francesco Correa
The session chaired by Marialuisa Zedde and Robin Lemmens started with a first speech given by Richard Perry (UK), Queen Square on the topic Thrombotic and cerebrovascular complications of COVID-19 which discussed the direct effects of covid induced coagulopathy together with the latest updates offered by recent publications available in the field. What clinicians saw is not a simple DIC due also to direct damage with invasion of the virus on their CNS and a related cytokine storm. Smallar case series are available in literature with typical large artery thrombosis. The first observation reported an increase of stroke admission during the first wave in Italy. Different data were observed in later studies with a fall of mild stroke admission. Excepted for a rise of median stroke severity. Others provocative studies suggested a protective effects of covid from a NYC study. Case series demonstrated incidence percentages between 0,09 up to 5 %. Controlled studies demonstrated higher risk in the first 14 days after covid.
SETICOS study showed more severe stroke cases according to NIHSS scores not an higher risks of LVOs respect to controls. This study showed a broader distribution of d-dimer levels than controls and the stroke outcome was worse than controls with a doubled mortality.
The second speech on COVID-19 and cerebral venous thrombosis by Andrei Alexandrov (United States) showed interesting data from NYC in hospitals converted to covid with fast mortality trends changes through time and neurological symptoms were very common among COVID19 patients. The study done in NYC metropolitan area reported 12 cases of CVT with incidence of 8.8 : 10000 while in Singapore with a local better control of the pandemic were found 6 cases after covid and with 83:10.000 and a rate of post vaccine CVT of 2.5:10.000. was pointed out a potential over use of heparin with harmful consequences a case study reported 552 world wide cases while another Germany study found post vaccine CVT with 0.55 on all vaccines with up to 1.53:100.000 higher incidence while chadoX vaccine was considered. Vector based vaccines showed higher risk of CVT / TTC and related complications with increased mortality.
The third speech was on “New adaptations to accelerate for reperfusion therapies in the COVID-19 era” by Amrou Sarraj (United States) He reported how hypercoagulability effects on COVID 19 may affect delivery of thrombolysis with a global drop in hospitalization, also an 11% drop in the use of r-Tpa. Also endovascular trombetto was reduced 19% as cause of hospitalization.
Literature studies showed how during the study period taken int account less procedures were done. The use of RAPID software was reduced by 39% as well. How to treat stroke on the covid era was a relevant topic on how to maintain stroke care. Prehospital triage was the first point together with the improvement of the use of Telestroke, therapy pathways alse needed to be remodulated,. Obtaining a consent to participation in clinical trials was also problematic and telephone consent was used together with e-consent. In COVID times many case series demonstrated good outcome of mechanical procedure with a decline on enrollment.
The forth talk was on Intracerebral hemorrhage: implications for management in patients infected by SARS-CoV2 by Barbara Casolla (France) she pointed out how the causal link between COVID19 and cerebrovascular events is not clear. Also ICH may be affected from COVID19 between 1.14 to 3% is the range of incidence of ICH in covid 19 while cosidering all types of ICH 7-12%
The potential mechanisms is connected with endothelial and inflammatory processes that effects the blood brain barriers. Those suffering from ICH during covid19 demonstrated higher levels of inflammatory markers at admission : such as leukocytes, CRP, D-dimer with a worse outcome. Other reported the use of anticoagulants in ICH during COVID 19 more often finding of a lobar ICH. With often a contemporary hyperacute growth of hematoma volume. The use of anticoagulants in COVID19 population bring a 5 fold increase of ICH due probably to an underlying coagulopathy. ECMO for COVID19 demonstrated a 6 fold increase of ICH due to underlying specific conditions.
The last speech of the session was on the Adaptations of stroke unit care and organization: lessons from a pandemic to benefit long term care by Apostolos Safouris (Greece) he reported how cunfuse pandemic plans showed the weakness of many health care systems during the first waves. The post COVID19 health care community now is using as countermeasures the following options: Big data analysis, specific adaptation of stroke services, the larger use of telemedicine, escalation protocols, empowerment of the population with increased informal communication between patients and phisicians.