COVID-19-Associated Carotid Atherothrombosis and Stroke

Esenwa, Charles; Cheng, Natalie; Lipsitz, Evan C.; Hsu, Kevin; Zampolin, Richard L.; Gersten, A.; Antoniello, Daniel; Soetanto, Ainie; Kirchoff, Katie; Liberman, Ava L; Mabie, Peter C.; Nisar, Taha; Rahimian, David; Brook, Allan; Lee, S.-K.; Haranhalli, Neil; Altschul, David; Labovitz, Daniel L.

doi:10.3174/ajnr.a6752

Cited by 29 publications

(20 citation statements)

References 15 publications

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“…In 2 patients a thrombus in the aortic arch was also found. 2 , 18 In the 5 cases in which a CEA was performed 3 , 18 , 19 the findings were organized thrombus moderately adherent to a soft CCA wall. Esenwa et al 18 analyzed the CCA wall in 3 cases and all of them found intima inflammatory infiltrates in the wall adherent to the thrombus.…”

Section: Discussionmentioning

confidence: 97%

“… 2 , 18 In the 5 cases in which a CEA was performed 3 , 18 , 19 the findings were organized thrombus moderately adherent to a soft CCA wall. Esenwa et al 18 analyzed the CCA wall in 3 cases and all of them found intima inflammatory infiltrates in the wall adherent to the thrombus. The authors suggest that, in patients with COVID-19, areas of mild carotid atherosclerosis may be particularly prone to thrombus formation because of the unique combination of endothelitis and COVID-19-associated coagulopathy.…”

Section: Discussionmentioning

confidence: 97%

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Symptomatic Common Carotid Free-Floating Thrombus in a COVID-19 Patient, Case Report and Literature Review

Cancer-Pérez

Alfayate-García

Vicente-Jiménez

et al. 2021

Annals of Vascular Surgery

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Carotid free-floating thrombus is an uncommon entity that usually presents with neurologic symptoms. Crescendo transient ischemic attack is an accepted indication for urgent carotid endarterectomy. COVID-19 is associated with severe thromboembolic complications. We report the case of a 61-year-old man who developed, 2 weeks after the diagnosis of COVID-19, crescendo transient ischemic attack, complicating a large intraluminal floating thrombus within the right common carotid artery. A carotid thromboendarterectomy under local anesthesia, with patch closure was immediately performed without complications. We conducted a literature review to identify cases of common carotid artery thrombus related to COVID-19. Carotid free-floating thrombus in the common carotid artery is exceptional. However, since the beginning of the COVID-19 pandemic, 15 cases have been published.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Symptomatic Common Carotid Free-Floating Thrombus in a COVID-19 Patient, Case Report and Literature Review

Cancer-Pérez

Alfayate-García

Vicente-Jiménez

et al. 2021

Annals of Vascular Surgery

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“…Indes et al [ 178 ] also reported an elevation of risk for acute arterial thromboembolic complications in patients with COVID-19 infection. Esenwa et al [ 179 ] presented a radiology-pathology case series of three COVID-19 patients and reported that a disproportionately high intra-luminal thrombus in the carotid artery showing mild-to-moderate atherosclerotic disease with intimal thickening and plaque calcification. Mohamud et al [ 180 ] presented a case study of six COVID-19 patients that had atherosclerotic plaque vulnerability and the development of thrombotic events.…”

Section: Role Of Atherosclerosis Imaging In Diabetes Patients During mentioning

confidence: 99%

Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review

Viswanathan¹,

Puvvula²,

Jamthikar³

et al. 2021

WJD

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Coronavirus disease 2019 (COVID-19) is a global pandemic where several comorbidities have been shown to have a significant effect on mortality. Patients with diabetes mellitus (DM) have a higher mortality rate than non-DM patients if they get COVID-19. Recent studies have indicated that patients with a history of diabetes can increase the risk of severe acute respiratory syndrome coronavirus 2 infection. Additionally, patients without any history of diabetes can acquire new-onset DM when infected with COVID-19. Thus, there is a need to explore the bidirectional link between these two conditions, confirming the vicious loop between “DM/COVID-19”. This narrative review presents (1) the bidirectional association between the DM and COVID-19, (2) the manifestations of the DM/COVID-19 loop leading to cardiovascular disease, (3) an understanding of primary and secondary factors that influence mortality due to the DM/COVID-19 loop, (4) the role of vitamin-D in DM patients during COVID-19, and finally, (5) the monitoring tools for tracking atherosclerosis burden in DM patients during COVID-19 and “COVID-triggered DM” patients. We conclude that the bidirectional nature of DM/COVID-19 causes acceleration towards cardiovascular events. Due to this alarming condition, early monitoring of atherosclerotic burden is required in “Diabetes patients during COVID-19” or “new-onset Diabetes triggered by COVID-19 in Non-Diabetes patients”.

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“…The events occurred mostly in the second week from onset of symptoms (8.5 ± 5.8 days) [ 61 ]. Several case report series evidenced massive carotid artery thrombosis in COVID-19 patients, with relatively low extent of atherosclerotic plaques and high levels of inflammatory biomarkers highlighting the impact of systemic inflammation and endothelial dysfunction on atherosclerotic plaques of any localization in the vascular system [ 62 , 63 , 64 ]. In a single center study, which included 388 COVID-19 patients from Milan, Italy, the authors reported a 7.7% ( n = 28) cumulative incidence of arterial and venous thrombotic events, with higher rates of events in ICU patients compared to general ward (16.7%, 95%CI 8.7%–29.6% vs. 6.4%, 95%CI 4.2%–9.6%), with most frequent clinical presentation of venous thromboembolism (8.3% in ICU vs. 3.8% on general ward).…”

Section: Covid-19—a Trigger For Systemic Thrombosismentioning

confidence: 99%

Imaging Cardiovascular Inflammation in the COVID-19 Era

et al. 2021

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Cardiac complications are among the most frequent extrapulmonary manifestations of COVID-19 and are associated with high mortality rates. Moreover, positive SARS-CoV-2 patients with underlying cardiovascular disease are more likely to require intensive care and are at higher risk of death. The underlying mechanism for myocardial injury is multifaceted, in which the severe inflammatory response causes myocardial inflammation, coronary plaque destabilization, acute thrombotic events, and ischemia. Cardiac magnetic resonance (CMR) imaging is the non-invasive method of choice for identifying myocardial injury, and it is able to differentiate between underlying causes in various and often challenging clinical scenarios. Multimodal imaging protocols that incorporate CMR and computed tomography provide a complex evaluation for both respiratory and cardiovascular complications of SARS-CoV2 infection. This, in relation to biological evaluation of systemic inflammation, can guide appropriate therapeutic management in every stage of the disease. The use of artificial intelligence can further improve the diagnostic accuracy of these imaging techniques, thus enabling risk stratification and evaluation of prognosis. The present manuscript aims to review the current knowledge on the possible modalities for imaging COVID-related myocardial inflammation or post-COVID coronary inflammation and atherosclerosis.

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COVID-19-Associated Carotid Atherothrombosis and Stroke

Cited by 29 publications

References 15 publications

Symptomatic Common Carotid Free-Floating Thrombus in a COVID-19 Patient, Case Report and Literature Review

Symptomatic Common Carotid Free-Floating Thrombus in a COVID-19 Patient, Case Report and Literature Review

Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review

Imaging Cardiovascular Inflammation in the COVID-19 Era

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