July 2020 | Issue 38 Thrombectomy proved efficacious in Latin America Page 10
Richard P Klucznik:
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COVID-19 causes “widespread disruption” to neuroendovascular research around the globe “Widespread disruption of neuroendovascular trials occurred because of COVID-19,” conclude the investigators of a survey-based study examining the impact of the pandemic. Now, as sites begin to resume clinical research, first author Ansaar T Rai of West Virginia University, Rockefeller Neuroscience Institute (Morgantown, USA), and colleagues throughout the USA call for steps to mitigate similar challenges that may arise in the future.
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he study, recently published in the Journal of NeuroInterventional Surgery (JNIS), focused on randomised controlled trials (RCTs) and singlearm studies for acute ischaemic stroke and cerebral aneurysms. The survey was developed by a group of senior neurointerventionalists, subsequently sent to sites identified through the clinical trials website, study sponsors, and physician investigators. “The survey was sent to 101 institutions, with 65 responding,” state Rai et al, as they added that stroke RCTs were (prior to the pandemic) being conducted at 40 sites, aneurysm RCTs at 22 sites, stroke single-arm studies at 37 sites, and aneurysm single-arm studies at 43 sites. However, following COVID-19, the authors report that enrolment was suspended at 51 (78%) sites; completely at 21, and partially at 30. Moreover, missed trial-related clinics, imaging follow-ups and protocol deviations were reported by 27, 24, and 27 sites, respectively. Negative reimbursements were reported at 17 sites. The majority of sites, Rai and colleagues note, were forced to put new trials on hold. The team found that many study coordinators (63%) worked from home, and 31% reported a personal financial impact. While remote consent was possible for some studies at 34 sites, only five sites reported that remote consent presented a viable option for all studies underway. Regarding the 51 sites with suspended trials, endovascular treatment without enrolment occurred at 61% of sites for stroke, and 45% of sites for aneurysms. Rai and the team found that this resulted in a total of 277 patients with acute ischaemic stroke, and a further 184 patients with cerebral aneurysms being treated Ansaar without consideration for Rai
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Non-invasive vagus nerve stimulation may provide clinical benefit to patients with COVID-19
An article accepted into the journal Neuromodulation has concluded that, based on two case reports, non-invasive vagus nerve stimulation (nVNS) might provide clinical benefits in patients with COVID-19 via “multiple mechanisms”. WHILE MOST COVID-19 cases are mild, the authors, Peter Staats (electroCore, Basking Ridge, USA) and colleagues acknowledge that a minority of patients develop moderate to severe respiratory symptoms, which they say appear to be due to a hyperimmune
reaction—otherwise known as a “cytokine storm”. “While the search for an antiviral, or a vaccine effective for SARS-CoV-2, the virus causing COVID-19, remains a priority, we also need to put resources and an effort to solving this cytokine
storm,” Staats tells NeuroNews. As VNS has been demonstrated to block production of cytokines in sepsis in animal models and in many other medical conditions (including PTSD, Sjogrens disease, rheumatoid arthritis, and stroke), Staats and his team hypothesised that nVNS might provide clinical benefits in patients with respiratory symptoms, such as those exhibited in the novel coronavirus. The information on the two case reports was obtained via email correspondence and phone interviews with the patients. According to the authors, in case 1, the patient used nVNS to aid his recovery at home after hospital discharge, and was subsequently able to discontinue use of opioids and cough suppressant medications. In case 2, the
patient experienced reliable relief from chest tightness and dyspnea within five minutes of using the stimulation. He also observed an improved ability to clear his lungs when he used nVNS to manage his symptoms at home. “Avoidance of ventilator dependence in both cases and lack of hospitalisation in case 2 cannot be causally attributed to nVNS, but it is reasonable to speculate that nVNS therapy may have been a supporting factor, via either bronchodilation or inhibition of cytokine release,” argue Staats and colleagues. They add, given the concerns about number of intensive care unit beds and ventilators amid the pandemic, that it is “imperative to consider all viable therapeutic options”. Thus, they put forward that “the well-established safety Continued on page 16