COVID-19-Related Aortic Thrombosis: A Report of Four Cases

Gómez-Arbeláez, Diego; Ibarra-Sanchez, Gabriela; García-Gutiérrez, Ania; Comanges-Yeboles, Alejandra; Ansuátegui, Marina; González-Fajardo, J.A.

doi:10.1016/j.avsg.2020.05.031

Cited by 73 publications

(106 citation statements)

References 10 publications

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“…Comparing these patients with our stroke registry of 8,929 AIS patients (GNSIS, Geisinger NeuroScience Ischemic Stroke database) indicated a higher prevalence of patients with no known risk factor (22.0% in this study versus 11.5% in GNSIS, p<0.001). We also observed that the patients in this study were younger (60.0±18.0 years versus 62.9±17.6 years, p=0.004) and had more severe strokes (NIHSS of 8 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Among the AIS patients, 13.6% of patients received intravenous thrombolysis, while 7.4% underwent mechanical thrombectomy. These rates are similar to the multinational study on 174 AIS SARS-CoV-2 infected patients (12.7% thrombolysis, 6.9% thrombolysis, and thrombectomy, and 5.2% mechanical thrombectomy).…”

Section: Discussionsupporting

confidence: 58%

SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group

Shahjouei

Tsivgoulis

Farahmand

et al. 2020

Preprint

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Background: Stroke is reported as a consequence of SARS-CoV-2 infection. However, there is a lack of regarding comprehensive stroke phenotype and characteristics Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke (AIS), intracranial hemorrhage (ICH), and cerebral venous or sinus thrombosis (CVST) among SARS-CoV-2 infected patients. We further investigated the association of demographics, clinical data, geographical regions, and countrie's health expenditure among AIS patients with the risk of large vessel occlusion (LVO), stroke severity as measured by National Institute of Health stroke scale (NIHSS), and stroke subtype as measured by the TOAST criteria. Additionally, we applied unsupervised machine learning algorithms to uncover possible similarities among stroke patients. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least one eligible stroke patient. Out of 432 patients included, 323(74.8%) had AIS, 91(21.1%) ICH, and 18(4.2%) CVST. Among 23 patients with subarachnoid hemorrhage, 16(69.5%) had no evidence of aneurysm. A total of 183(42.4%) patients were women, 104(24.1%) patients were younger than 55 years, and 105(24.4%) patients had no identifiable vascular risk factors. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144(37.8%) presented to the hospital with chief complaints of stroke-related symptoms, with asymptomatic or undiagnosed SARS-CoV-2 infection. Among AIS patients 44.5% had LVO; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median NIHSS (8[3-17], versus 11[5-17]; p=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; p<0.001) in countries with middle to high-health expenditure when compared to countries with lower health expenditure. The unsupervised machine learning identified 4 subgroups, with a relatively large group with no or limited comorbidities. Conclusions: We observed a relatively high number of young, and asymptomatic SARS-CoV-2 infections among stroke patients. Traditional vascular risk factors were absent among a relatively large cohort of patients. Among hospitalized patients, the stroke severity was lower and rate of mechanical thrombectomy was higher among countries with middle to high-health expenditure.

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Section: Discussionsupporting

confidence: 58%

SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group

Shahjouei

Tsivgoulis

Farahmand

et al. 2020

Preprint

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“…The spectrum of presentation of hypercoagulability states in COVID-19 encompasses a wide range that spans from localized microvascular thrombosis in the lungs or pulmonary intravascular coagulopathy (PIC) to systemic venous and arterial thrombosis, including aortic thrombosis [88][89][90]. Development of COVID-19-associated coagulopathy is associated with a worse prognosis [91].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool

et al. 2020

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Background: Coronavirus disease 2019 (COVID-19) pandemic has drastically affected global health. Despite several studies, there is yet a dearth of data regarding the mechanisms of cardiac injury, clinical presentation, risk factors, and treatment of COVID-19-associated cardiovascular disease. This systematic review and meta-analysis is aimed at defining the clinical, electrocardiographic, and pathologic spectrum of cardiovascular disease (CVD), frequency of elevated cardiac and inflammatory biomarkers, and their frequency and relationship with severity of the disease and mortality in COVID-19 patients and to develop a triage risk stratification tool (TRST) that can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy. We conducted an online search in databases of PubMed and Embase to identify relevant studies. Data selection was in concordance with PRISMA guidelines. Results were presented as pooled frequencies, odds ratio, standardized mean difference (SMD), and forest and funnel plots. Results: We gathered a total of 54 studies and included 35 of them in our meta-analysis. Acute cardiac injury occurred in more than 25% of cases, mortality was 20 times higher, and admission to intensive care unit increased by 13.5 times. Hypertension was the most common pre-existing comorbidity with a frequency of 29.2%, followed by diabetes mellitus (13.5%). The deceased group of patients had higher cardiac and inflammatory biomarkers, with statistically significant SMD, compared with survivors. Pediatric patients were predominantly mildly affected. However, less frequently, the presentation was very similar to Kawasaki disease or Kawasaki shock syndrome. This latter presentation hass been called as multisystem inflammatory syndrome in children (MIS-C). Conclusions: There is a wide spectrum of cardiac involvement in COVID-19 patients, and hence a Triage Risk Stratification Tool can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy.

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“… 21 USA Case report 1 1 (100) 64 1 (100) CNS (ICA) CT head None Hypertension 1 (100) Gomez-Arbelaez et al. 22 Spain Case series 4 4 (100) 50–76 3 (75) Aortoiliac 2; CNS-1; aortic arch 1; thoracic aorta 1; common carotid 1 CT angiography DVT, PE HTN, dyslipidemia 1 (25) Harari et al. 23 USA Case report 1 1 (100) 40 0 (0) Heart (left coronary artery) Coronary angiography None DM, HTN, hyperlipidemia, and schizophrenia 1 (100) Helms et al.…”

Section: Methodsmentioning

confidence: 99%

Arterial Thrombosis in Coronavirus Disease 2019 Patients: A Rapid Systematic Review

Cheruiyot

Kipkorir

Ngure

et al. 2021

Annals of Vascular Surgery

144

153

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Background Emerging evidence suggests that severe form of coronavirus disease 2019 (COVID-19) is mediated, in part, by a hypercoagulable state characterized by micro- and macro-vascular thrombotic angiopathy. Although venous thrombotic events in COVID-19 patients have been well described, data on arterial thrombosis (AT) in these patients is still limited. We, therefore, conducted a rapid systematic review of current scientific literature to identify and consolidate evidence of AT in COVID-19 patients. Methods A systematic search of literature was conducted between November 1, 2019, and June 9, 2020, on PubMed and China National Knowledge Infrastructure to identify potentially eligible studies. Results A total of 27 studies (5 cohort, 5 case series, and 17 case reports) describing arterial thrombotic events in 90 COVID-19 patients were included. The pooled incidence of AT in severe/critically ill intensive care unit–admitted COVID-19 patients across the 5 cohort studies was 4.4% (95% confidence interval 2.8–6.4). Most of the patients were male, elderly, and had comorbidities. AT was symptomatic in >95% of these patients and involved multiple arteries in approximately 18% of patients. The anatomical distribution of arterial thrombotic events was wide, occurring in limb arteries (39%), cerebral arteries (24%), great vessels (aorta, common iliac, common carotid, and brachiocephalic trunk; 19%), coronary arteries (9%), and superior mesenteric artery (8%). The mortality rate in these patients is approximately 20%. Conclusions AT occurs in approximately 4% of critically ill COVID-19 patients. It often presents symptomatically and can affect multiple arteries. Further investigation of the underlying mechanism of AT in COVID-19 would be needed to clarify possible therapeutic targets.

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COVID-19-Related Aortic Thrombosis: A Report of Four Cases

Cited by 73 publications

References 10 publications

SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group

SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group

Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool

Arterial Thrombosis in Coronavirus Disease 2019 Patients: A Rapid Systematic Review

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