Large vessel stroke in six patients following SARS‐CoV‐2 infection: a retrospective case study series of acute thrombotic complications on stable underlying atherosclerotic disease

Abstract

Background and purpose: Ischaemic stroke has been described in association with COVID-19. Several pathophysiological mechanisms have been suggested, i.e. prothrombotic state, cardiac injury etc. It was sought to assess the potential association between ischaemic stroke associated with SARS-CoV-2 infection and underlying atherosclerotic lesions. Methods: A retrospective analysis of stroke related to large vessel occlusion was conducted amongst patients with SARS-CoV-2 infection and underlying mild atherosclerotic disease, between 19 March and 19 April 2020 in six different stroke centers in theÎle-de France area, France. Results: The median age was 52 years, median body mass index was 29.5 kg/ m 2. All patients displayed previous vascular risk factors such as high blood pressure, diabetes, dyslipidemia or body mass index > 25. The delay between the first respiratory symptoms of COVID-19 and stroke was 11.5 days. At baseline, all had tandem occlusions, i.e. intracerebral and extracerebral thrombus assessed with computed tomography or magnetic resonance imaging. Cases displayed a large thrombus in the cervical carotid artery with underlying mild non-stenosing atheroma, after an etiological workup based on angio-computed tomography or magnetic resonance imaging and/or cervical echography. Conclusion: Our study should alert clinicians to scrutinize any new onset of ischaemic stroke during COVID-19 infection, mainly in patients with vascular risk factors or underlying atherosclerotic lesions.

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

“…Similarly, the formation of atherosclerotic thrombus in the arteries has been reported in recent studies[ 177 ]. Lapergue et al [ 177 ] reported COVID-19 patients that showed the development of large thrombus in the cervical carotid artery with underlying mild non-stenosing atheroma.…”

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

“…( Table I ). Another 2 COVID-19 patients with CCA totally occluded have been published, 22 , 23 these cases were excluded from the review because they did not meet our inclusion criteria. All patients presented with stroke as the chief symptom, and COVID-19 manifestations of mild severity.…”

Endovascular Thrombectomy of COVID-19-Related Large Vessel Occlusion: A Systematic Review and Summary of the Literature

“…This contrasts to the NIHSS of 40 in the patient with basilar occlusion, which was reported in 12.5% of the overall included patient pool. Re-evaluation of the NIHSS at 24 h after presentation, which was reported in three of the eight studies, demonstrated no significant difference with the NIHSS at presentation, suggesting EVT has minimal effect in the acute phase [ 19 , 20 •].…”