Emergent Carotid Artery Stenting Following Intravenous Alteplase Infusion After Rapid Negative Diagnosis for COVID-19 by Loop-Mediated Isothermal Amplification Assay.
Aged
Arginine
/ analogs & derivatives
COVID-19
/ diagnosis
Carotid Stenosis
/ complications
Combined Modality Therapy
Fibrinolytic Agents
/ therapeutic use
Hemiplegia
/ etiology
Humans
Ischemic Stroke
/ drug therapy
Magnetic Resonance Imaging
Male
Molecular Diagnostic Techniques
Nucleic Acid Amplification Techniques
Pipecolic Acids
/ therapeutic use
Platelet Aggregation Inhibitors
/ therapeutic use
Stents
Sulfonamides
/ therapeutic use
Tissue Plasminogen Activator
/ therapeutic use
Tomography, X-Ray Computed
Treatment Outcome
Acute ischemic stroke
Alteplase
COVID-19
Carotid artery stenting
Emergency
LAMP assay
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
16
07
2020
revised:
28
09
2020
accepted:
30
09
2020
pubmed:
13
10
2020
medline:
31
12
2020
entrez:
12
10
2020
Statut:
ppublish
Résumé
During the coronavirus disease 2019 (COVID-19) pandemic, a rapid screening method for COVID-19 detection is needed to decide the appropriate strategy to treat stroke patients. In acute ischemic stroke treatment, the efficacy and safety of emergent carotid artery stenting (eCAS) for hyperacute ischemic stroke (hAIS) due to internal carotid artery stenosis (ICS) have not been sufficiently established. A 71-year-old man with hAIS caused by severe ICS was treated via intravenous alteplase infusion. The patient underwent screening for COVID-19 by the loop-mediated isothermal amplification (LAMP) assay shortly after arrival at our institution. The LAMP result was obtained within 90 minutes, during intravenous alteplase infusion, and turned out to be negative. The symptom of hemiplegia worsened during alteplase infusion, and he, therefore, underwent eCAS after administration of aspirin (200 mg). Recanalization was achieved successfully by eCAS, and dual antiplatelet therapy and argatroban were administrated following eCAS. Hemorrhagic complications or restenosis/occlusion of the carotid artery were not observed. He was discharged without neurologic deficits 15 days following eCAS. Because of the rapid negative diagnosis for COVID-19 using the LAMP method, eCAS could be performed following standard procedures, along with infectious defense, without delay. This case report suggests that eCAS for hAIS due to ICS following intravenous alteplase can be an effective treatment, along with appropriate antiplatelet medication and management in select patients. During the COVID-19 pandemic, the LAMP assay for COVID-19 detection might be a suitable diagnostic strategy preceding stroke treatment because of the rapid turnaround time.
Sections du résumé
BACKGROUND
During the coronavirus disease 2019 (COVID-19) pandemic, a rapid screening method for COVID-19 detection is needed to decide the appropriate strategy to treat stroke patients. In acute ischemic stroke treatment, the efficacy and safety of emergent carotid artery stenting (eCAS) for hyperacute ischemic stroke (hAIS) due to internal carotid artery stenosis (ICS) have not been sufficiently established.
CASE DESCRIPTION
A 71-year-old man with hAIS caused by severe ICS was treated via intravenous alteplase infusion. The patient underwent screening for COVID-19 by the loop-mediated isothermal amplification (LAMP) assay shortly after arrival at our institution. The LAMP result was obtained within 90 minutes, during intravenous alteplase infusion, and turned out to be negative. The symptom of hemiplegia worsened during alteplase infusion, and he, therefore, underwent eCAS after administration of aspirin (200 mg). Recanalization was achieved successfully by eCAS, and dual antiplatelet therapy and argatroban were administrated following eCAS. Hemorrhagic complications or restenosis/occlusion of the carotid artery were not observed. He was discharged without neurologic deficits 15 days following eCAS. Because of the rapid negative diagnosis for COVID-19 using the LAMP method, eCAS could be performed following standard procedures, along with infectious defense, without delay.
CONCLUSIONS
This case report suggests that eCAS for hAIS due to ICS following intravenous alteplase can be an effective treatment, along with appropriate antiplatelet medication and management in select patients. During the COVID-19 pandemic, the LAMP assay for COVID-19 detection might be a suitable diagnostic strategy preceding stroke treatment because of the rapid turnaround time.
Identifiants
pubmed: 33045450
pii: S1878-8750(20)32185-9
doi: 10.1016/j.wneu.2020.09.166
pmc: PMC7546639
pii:
doi:
Substances chimiques
Fibrinolytic Agents
0
Pipecolic Acids
0
Platelet Aggregation Inhibitors
0
Sulfonamides
0
Arginine
94ZLA3W45F
Tissue Plasminogen Activator
EC 3.4.21.68
argatroban
IY90U61Z3S
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
356-359Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Références
J Neurointerv Surg. 2020 Jun;12(6):539-541
pubmed: 32295835
N Engl J Med. 2020 Feb 20;382(8):727-733
pubmed: 31978945
Stroke. 2020 May;51(5):1356-1357
pubmed: 32228369
Microb Biotechnol. 2020 Jul;13(4):950-961
pubmed: 32333644
N Engl J Med. 2015 Jan 1;372(1):11-20
pubmed: 25517348
N Engl J Med. 2015 Mar 12;372(11):1019-30
pubmed: 25671798
N Engl J Med. 2015 Mar 12;372(11):1009-18
pubmed: 25671797
N Engl J Med. 2008 Apr 10;358(15):1572-9
pubmed: 18403765
J Neurointerv Surg. 2013 Jan 1;5(1):40-4
pubmed: 22170821
N Engl J Med. 2015 Jun 11;372(24):2296-306
pubmed: 25882510
Intern Med. 2016;55(19):2869-2872
pubmed: 27725550
Neurosurgery. 2020 Jul 1;87(1):E63-E65
pubmed: 32277754
Lancet. 2016 Apr 23;387(10029):1723-31
pubmed: 26898852
Med Hypotheses. 2020 Aug;141:109786
pubmed: 32361529
N Engl J Med. 2015 Jun 11;372(24):2285-95
pubmed: 25882376
J Am Coll Cardiol. 2011 Nov 29;58(23):2363-9
pubmed: 22115640
World Neurosurg. 2020 Jul;139:344-354
pubmed: 32387786
AJNR Am J Neuroradiol. 2005 May;26(5):1249-58
pubmed: 15891193
N Engl J Med. 1995 Dec 14;333(24):1581-7
pubmed: 7477192
Clin Microbiol Infect. 2020 Jun;26(6):773-779
pubmed: 32276116
Neurology. 2020 May 19;94(20):886-891
pubmed: 32253352
Stroke. 2020 Jun;51(6):1891-1895
pubmed: 32233980
N Engl J Med. 2008 Sep 25;359(13):1317-29
pubmed: 18815396