901 - Case series of stellate ganglion cryoablation in patients with long COVID-19

Case Diagnosis: Post-Acute Sequelae of COVID-19, also known as long COVID. 
Stellate ganglion blocks have shown effectiveness in the treatment of symptoms related to long COVID, but length of symptomatic relief is limited. Here we review a small case series of patients with long COVID who underwent stellate ganglion cryoablation which resulted in long COVID symptom relief for over six months in all cases.
 
 

Case Description:  
 
Three patients with long COVID symptoms (orthostatic intolerance, abnormalities in proprioception, fatigue, and brain fog) who had significant relief of symptoms after receiving stellate ganglion block (SGB) but had recurrence of their symptoms after 4-8 weeks were eligible for a stellate ganglion cryoablation. Laterality of cryoablation procedure was determined by laterality of prior positive stellate ganglion block. Under CT and ultrasound-guidance, two patients underwent left stellate ganglion cryoablation while the other underwent right stellate ganglion cryoablation. Each procedure was performed under general anesthesia using a single cryoablation probe and one 8-minute freeze cycle. Symptoms were recorded prior to and up to 12 months after cryoablation.

Discussions:  
All patients reported significant improvement in symptoms related to dysautonomia and brain fog. One patient reported resolution of her anosmia, which had previously resolved post block but recurred after an upper respiratory infection prior to the cryoablation. One patient had over a year of symptom relief until her symptoms returned after a stressful life event. All patients experienced upper limb pain felt to represent neuritis ipsilateral to the side of the cryoablation that lasted 6 weeks. In all cases, pain was successfully managed conservatively with oral medications.

Conclusions: This small case series suggests that stellate ganglion cryoablation may be a safe, minimally invasive procedure that can improve patient symptoms related to long COVID if the effects of a block wear off, one patient with symptomatic relief maintained over one year.