Recommendations for Management of Ischemic Stroke in Adults With COVID-19

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A panel prepared a comprehensive set of practice implications for clinicians caring for adults with acute ischemic stroke with confirmed or suspected of having COVID-19.

A comprehensive set of practice implications for the management of acute ischemic adults in patients with COVID-19 was developed by a panel of international experts and published in the International Journal of Stroke.

Following the declaration of coronavirus disease 2019 (COVID-19) as a pandemic, and reports describing some patients presenting with transient ischemic attack or stroke, a panel of members from 18 countries reviewed the literature and prepared a comprehensive set of practice implications for clinicians caring for adults with acute ischemic stroke with confirmed or suspected of having COVID-19.

While the underlying cause is unclear, patients with COVID-19 are at increased risk for developing acute stroke.  Several factors may impair the possibility to complete appropriate screening of patients with stroke for COVID-19. Therefore, patients with stroke suspected of having COVID-19 should be evaluated under the assumption that they have COVID-19 and chest imaging may be helpful.

The available data suggests that healthcare providers treating patients with acute stroke are at risk of acquiring COVID-19, though the risk for infection is probably lower compared to the risk of providers involved in the evaluation of respiratory or infectious diseases. The stroke team must use every precaution to reduce the transmission risk during evaluation of acute stroke patients, including maintaining a distance of 2m, using surgical mask, gloves, gowns, and hand washing, along with minimizing the number of providers and the use of Telestroke, when appropriate.

To avoid contamination of the environment and exposure to staff, it is advisable to create a stroke green pathway that is separated from potentially contaminated ED, along with ad hoc pathway in the case of a patient with confirmed or suspected COVID-19.

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The providers should be aware of the potential complications associated with COVID-19, including the high rate of acute kidney injury, when considering CT angiography and perfusion images to select patients for mechanical thrombectomy or assess pulmonary abnormalities. Hepatic dysfunction and coagulopathy should also be taken into considerations in light of the relatively high prevalence of these complications in patients with COVID-19 and the potential impact on treatment for acute stroke.

Comprehensive and designated stroke centers must anticipate new challenges because of mismatch between demand and resources, and elective procedures may need to be deferred.

The experts call for additional data and believe that prospective registries may help to understand the differences in risk, manifestations, response to treatment strategies and outcomes in patients with stroke with may also have COVID-19.


Qureshi AI, Abd-Allah F, Alsenani F, et al. Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel [published online ahead of print, 2020 May 3]. Int J Stroke.  doi:10.1177/1747493020923234