Regional Mechanical Thrombectomy Imaging Protocol in Patients Presenting with Acute Ischemic Stroke during the COVID-19 Pandemic

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FIG 1.
Comparison of the patient pathways according to the COVID-19 risk. High risk for COVID-19 on admission included typical or indeterminate pulmonary findings on the chest CT and/or any clinical suspicion. Low risk for COVID-19 included atypical or normal findings on the chest CT and no clinical suspicion. Enhanced PPE indicates filtering facepiece class 3 masks, visors, and long-sleeved fluid-repellent overalls. Standard PPE indicates fluid-resistant surgical masks, gloves, and aprons; −ve, negative; +ve, positive.
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FIG 2.
Typical features of COVID-19 pneumonia. Axial CT images at the level of the hilum show bilateral ground glass opacities (arrows) with areas of lobular sparing and sparing of the immediate subpleural area. This patient tested positive by RT-PCR analysis.
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FIG 3.
Indeterminate features of COVID-19 pneumonia. Axial CT images show unilateral, localized, peripheral ground glass opacities (arrows). This patient tested negative for COVID-19 by RT-PCR analysis.

Table 1:

COVID-19 pneumonia imaging classification according to the CT findings^{^a}

COVID-19 Pneumonia Imaging Classification	Rationale	CT Findings
Typical appearance	Commonly reported imaging features of greater specificity for COVID-19 pneumonia	Peripheral, bilateral GGOs with or without consolidation or visible intralobular lines (crazy-paving)
		Multifocal GGOs of rounded morphology with or without consolidation or visible intralobular lines (crazy-paving)
		Reverse halo sign or other findings of organizing pneumonia (seen later in the disease)
Indeterminate	Nonspecific imaging features of COVID-19 pneumonia	Absence of typical features AND
		Presence of multifocal, diffuse, perihilar, or unilateral GGO with or without consolidation lacking a specific distribution; they are nonrounded or nonperipheral
		Few very small GGOs with a nonrounded and nonperipheral distribution
Negative	Uncommonly or not reported features of COVID-19 pneumonia	Absence of typical or indeterminate features AND
		Presence of isolated lobar or segmental consolidation without GGO
		Discrete small nodules (centrilobular, tree-in-bud sign)
		Lung cavitation
		Smooth interlobular septal thickening with pleural effusion
		OR no abnormal findings

Note:—GGO indicates ground glass opacity.
↵a Adapted from the proposed Radiological Society of North America and British Society of Thoracic Imaging chest CT classification for reporting of COVID-19 pneumonia.^15,16

Table 4:

List of incidental findings identified on review of the thoracic imaging in this cohort, summarized according to their clinical relevance

Incidental Pulmonary/CVS Findings of Substantial Clinical Relevance (n = Patients)	Incidental Pulmonary/CVS Findings of Indeterminate Clinical Relevance (n = Patients)
Lung malignancy/suspicious nodule²	Emphysema⁴
Pulmonary edema⁴	Lung fibrosis/pneumoconiosis³
Left ventricular thrombus/aneurysm²	Ascending aortic dilation²
Left atrial dilation: anterior-posterior diameter >45 mm¹⁶