Acute Ischemic Stroke Revealing ChAdOx1 nCov-19 Vaccine-Induced Immune Thrombotic Thrombocytopenia: Impact on Recanalization Strategy

Costentin, Guillaume; Ozkul-Wermester, Ozlem; Triquenot, Aude; Cam-Duchez, Véronique Le; Massy, Nathalie; Benhamou, Y.; Massardier, Evelyne

doi:10.1016/j.jstrokecerebrovasdis.2021.105942

Cited by 15 publications

(8 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therapeutic approach of acute ischemic stroke due to large vessel occlusion in VITT is challenging. Based on the available literature 89,[110][111][112][113][114][115][116][117][118][119] and our personal experience, 109 we propose the following management protocol for acute stroke patients presenting to the Emergency Department within the time window for reperfusion strategies (Figure 4):…”

Section: Therapeutic Implicationsmentioning

confidence: 99%

Cerebrovascular Complications of COVID-19 and COVID-19 Vaccination

Michele

Kahan

Berto

et al. 2022

Circulation Research

View full text Add to dashboard Cite

The risk of stroke and cerebrovascular disease complicating infection with SARS-CoV-2 has been extensively reported since the onset of the pandemic. The striking efforts of many scientists in cooperation with regulators and governments worldwide have rapidly brought the development of a large landscape of vaccines against SARS-CoV-2. The novel DNA and mRNA vaccines have offered great flexibility in terms of antigen production and led to an unprecedented rapidity in effective and safe vaccine production. However, as mass vaccination has progressed, rare but catastrophic cases of thrombosis have occurred in association with thrombocytopenia and antibodies against PF4 (platelet factor 4). This catastrophic syndrome has been named vaccine-induced immune thrombotic thrombocytopenia. Rarely, ischemic stroke can be the symptom onset of vaccine-induced immune thrombotic thrombocytopenia or can complicate the course of the disease. In this review, we provide an overview of stroke and cerebrovascular disease as a complication of the SARS-CoV-2 infection and outline the main clinical and radiological characteristics of cerebrovascular complications of vaccinations, with a focus on vaccine-induced immune thrombotic thrombocytopenia. Based on the available data from the literature and from our experience, we propose a therapeutic protocol to manage this challenging condition. Finally, we highlight the overlapping pathophysiologic mechanisms of SARS-CoV-2 infection and vaccination leading to thrombosis.

show abstract

Section: Therapeutic Implicationsmentioning

confidence: 99%

Cerebrovascular Complications of COVID-19 and COVID-19 Vaccination

Michele

Kahan

Berto

et al. 2022

Circulation Research

View full text Add to dashboard Cite

show abstract

“…Two records were excluded because the stroke was due to secondary vaccine-induced immune thrombocytopenia (ITP) and thrombotic thrombocytopenic purpura (TTP), respectively [ 10 , 11 ]. Eighteen articles ( n = 23 patients) [ 3 , 7 , 8 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] were included in our review. Baseline demographics, relevant clinical data, stroke characteristics, and outcome of patients described in these studies, including our case, are shown in Tables 1 and 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Most patients (83.3%) had no known prothrombotic factors. Among the remaining cases two young women were known to take the oral contraceptive pill [ 20 , 26 ], a 69-year-old man suffered from prostate cancer [ 15 ], and a 70-year-old man who had been diagnosed a metastatic pancreatic cancer during hospitalization [ 25 ]. Almost all patients had received the first dose of an adenoviral vector-based vaccine (ChAdOx1 nCoV-19 in 20 patients, Ad26.COV.2.S in 3 patients), only one patient had received a m-RNA-based vaccine (mRNA-1273).…”

Section: Resultsmentioning

confidence: 99%

Ischemic Stroke and Vaccine-Induced Immune Thrombotic Thrombocytopenia following COVID-19 Vaccine: A Case Report with Systematic Review of the Literature

Rizzo

Giussani

Agostoni³

2022

Cerebrovasc Dis

View full text Add to dashboard Cite

Introduction: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a prothrombotic syndrome observed after adenoviral vector-based vaccines for severe acute respiratory syndrome coronavirus 2. It is characterized by thrombocytopenia, systemic activation of coagulation, extensive venous thrombosis, and anti-platelet factor 4 antibodies. Arterial thrombosis is less common and mainly affects the aorta, peripheral arteries, heart, and brain. Several cases of ischemic stroke have been reported in VITT, often associated with large vessel occlusion (LVO). Here, we describe a case of ischemic stroke with LVO after Ad26.COV2.S vaccine, then we systematically reviewed the published cases of ischemic stroke and VITT following COVID-19 vaccination. Methods: We describe a 58-year-old woman who developed a thrombotic thrombocytopenia syndrome with extensive splanchnic vein thrombosis and ischemic stroke due to right middle cerebral artery (MCA) occlusion, 13 days after receiving Ad26.COV2.S vaccination. Then, we performed a systematic review of the literature until December 3, 2021 using PubMed and EMBASE databases. The following keywords were used: (“COVID-19 vaccine”) AND (“stroke”), (“COVID-19 vaccine”) AND (“thrombotic thrombocytopenia”). We have selected all cases of ischemic stroke in VITT. Results: Our study included 24 patients. The majority of the patients were females (79.2%) and younger than 60 years of age (median age 45.5 years). Almost all patients (96%) received the first dose of an adenoviral vector-based vaccine. Ischemic stroke was the presenting symptom in 18 patients (75%). Splanchnic venous thrombosis was found in 10 patients, and cerebral venous thrombosis in 5 patients (21%). Most patients (87.5%) had an anterior circulation stroke, mainly involving MCA. Seventeen patients (71%) had an intracranial LVO. We found a high prevalence of large intraluminal thrombi (7 patients) and free-floating thrombus (3 patients) in extracranial vessels, such as the carotid artery, in the absence of underlying atherosclerotic disease. Acute reperfusion therapy was performed in 7 of the 17 patients with LVO (41%). One patient with a normal platelet count underwent intravenous thrombolysis with alteplase, while 6 patients underwent mechanical thrombectomy. A malignant infarct occurred in 9 patients and decompressive hemicraniectomy was performed in 7 patients. Five patients died (21%). Conclusion: Our study points out that, in addition to cerebral venous thrombosis, adenoviral vector-based vaccines also appear to have a cerebral arterial thrombotic risk, and clinicians should be aware that ischemic stroke with LVO, although rare, could represent a clinical presentation of VITT.

show abstract

“…Safety of this treatment has been studied in small case series of AIS patients with thrombocytopenia. Seven cases of AIS with LVO who have thrombocytopenia underwent mechanical thrombectomy successfully and safely among our studied patients, 6 of them did not receive IV tPA prior to thrombectomy [ 29 , 108 , [110] , [111] , [112] ]. Cascio Rizzo et al also indicated that despite that re-occlusion after revascularization may happen due to the hypercoagulative state, mechanical thrombectomy is a feasible and safe treatment in patients with VITT and AIS [ 113 ].…”

Section: Resultsmentioning

confidence: 99%