LAUSR

The current COVID-19 global pandemic could potentially affect emergent large vessel occlusion (ELVO) ischemic stroke1 through at least two mechanisms. The first is possible increased stroke incidence due to procoagulant effects of the virus or the immune response to it.2–5 The second, more tangible, is the effect on ELVO triage and treatment times, a phenomenon already reported for emergent care of myocardial infarction6 and recently for acute stroke care during COVID-19 disruption in France.7 On the JNIS website currently is a paper from the Chinese epicenter, focused on the second of these. The authors present a single-center experience during the height of the pandemic (total lockdown in Wuhan until the end of newly diagnosed cases) and compare time intervals and procedural outcomes to pre-pandemic cases. Importantly, this is distinct from confirmed and suspected COVID-19 patients undergoing thrombectomy. Those patients were transferred from the community directly to a sequestered hospital environment; their treatment and outcomes after stroke remain unknown. Only limited case series have been published to date about treatment of known COVID-19-positive patients with stroke.8 9 The current paper is focused instead on the impact of the required modifications in the processes for patients with ELVO during the COVID-19 pandemic. Delays were expected because of expanded patient evaluation and staff protection …