Monash Health leads international review of ‘mini stroke’ pathways in response to COVID-19

Monash Health researchers Dr Andy Lim, Dr Shaloo Singhal, Dr Benjamin Clissold, Professor Thanh Phan and Professor Henry Ma have led an international study that looked at the effect of COVID-19 on the management pathway of transient ischemic attack (TIA) treatment pathways.

A TIA is a ‘mini-stroke’ which needs to be assessed quickly and adequately to reduce the risk of future strokes. With rapid access pathways, the risk of having a stroke in the next three months can be decreased from 1 in 10 to 1 in 50.

However, to lower the risk of COVID-19 transmission, face-to-face contact at hospitals around the world has been reduced, which can impact the effectiveness of TIA treatment pathways.

Professor Henry Ma, Adjunct Professor, Director of Neurology and Head of the Stroke Unit at Monash Health, explains the benefit of changing assessment from a carotid ultrasound to a computer tomography (CT) angiogram.

“Prior to COVID-19, if a patient was deemed appropriate for TIA pathway management, they would usually get a carotid ultrasound done within 24 hours (as an outpatient) to identify any significant carotid artery stenosis,” said Professor Ma.

“During COVID-19, we try to reduce patient contact, and avoid asking the patient to return the next day. Instead, we perform the CT during the initial emergency presentation. This provides an immediate assessment of the carotid artery, which can then guide treatment.”

Follow-up of ‘mini stroke’ patients can also be performed via telehealth, another measure which reduces the risk of COVID-19 transmission.

A global review of TIA treatment, conducted by Monash Health researchers, showed that all countries continued to support rapid access pathways throughout the pandemic, which highlights the importance of the treatment, compared to other services and treatments that have been put on hold.

The research report was “a global collaboration to study the impact of COVID-19 on the delivery of acute stroke care and its impact. More importantly, it also shows how health professionals have responded to the changes and ensure we can provide the best possible care,” said Professor Ma.

Dr Andy Lim, an emergency physician, led the collaboration between the emergency and neurology departments at Monash Health, and the global report showed that the adaptive practices at Monash Health were delivering TIA rapid access pathways at a pace that matched other world-leading hospitals and universities.

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