SARS-CoV-2-related vascular injury: mechanisms, imaging and models

Humayun, Lucas; Smith, Colin P.; Li, Wanlu; Zhang, Yu Shrike; Park, Christine; Feng, Wuwei; Yao, Junjie

doi:10.21037/mps-20-6

Cited by 4 publications

(10 citation statements)

References 52 publications

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“…Although new antivirals, including nirmatrelvir plus ritonavir (Paxlovid; Pfizer, New York, NY, USA), have been approved now for COVID-19 infection, it is still believed that the best strategy to terminate the pandemic depends on timely and appropriate immunizations worldwide [ 5 ]. Because the efficacy and safety of anti-COVID-19 vaccines were shown in the registration trials, their benefits are believed to outweigh the potential risk of complications [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, the anti-COVID-19 mRNA vaccine was developed faster than any vaccine in the past (thanks to the collaboration between researchers, scientists, manufacturers, and distributors in a never-before-seen approach), and it should be cautioned that immunization with limited experiences such as this can induce unexpected de novo vaccine-related disorders, including autoimmune diseases, particularly in predisposed individuals [ 5 , 6 ]. Furthermore, in addition to complications with a relatively clear causal relationship occurring in the early period after vaccination, associated morbidities manifesting in later periods with less unclear causal relationships should be carefully monitored.…”

Section: Discussionmentioning

confidence: 99%

“…In conjunction with the SARS-CoV-2 infection or anti-COVID-19 vaccination, vascular disorders have been recognized as organ-specific immune-mediated complications, and the number of reported cases is increasing [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The outbreak of COVID-19, which is caused by SARS-CoV-2, began in December 2019 in Wuhan, Hubei, China, and then, it became a pandemic [ 5 ]. Among the morbidities associated with COVID-19, vascular complications, including vasculopathy, thrombotic microangiopathy, and intravascular coagulopathy, are of increasing concern because devastating vital organ injuries could be induced at various stages of the disease progression [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…In line with this concept, the national vaccination program in Japan started on February 21, 2021, mainly by using the approved messenger RNA (mRNA) Comirnaty concentrate for dispersion of injection (Pfizer-BioNTech: Mainz, Germany). However, the rapid development and application of the novel mRNA vaccines come with a setback because studies on long-term unpredictable adverse effects remain insufficient [ 5 ]. Furthermore, reports on the potential risk of developing late adverse effects, including visceral vascular disorders, after receiving vaccination remain limited, particularly for the anti-COVID-19 mRNA vaccine [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

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A Case of Segmental Arterial Mediolysis of Multiple Visceral Arteries Following Anti-COVID-19 Vaccination: Late Complication or Rare Coincidence?

2022

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Patient: Male, 68-year-old Final Diagnosis: Segmental arterial mediolysis Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: General and Internal Medicine Objective: Unusual clinical course Background: Segmental arterial mediolysis (SAM) is a rare noninflammatory, nonatherosclerotic vascular disorder characterized by arterial media disruption. In conjunction with the SARS-CoV-2 infection or anti-COVID-19 vaccination, vascular disorders have been recognized as organ-specific immune-mediated complications, and the number of reported cases is gradually increasing. Case Report: A 68-year-old man presented with severe upper abdominal pain and nausea 58 days after a third injection of Pfizer-BioNTech anti-COVID-19 mRNA vaccination. An abdominal dynamic computed tomography angiography showed stenosis and dilatation of multiple visceral arteries, including the middle and right colic arteries. In the omental arteries, spindle-shaped dilatation and stenosis were identified. The left epiploic artery was not visualized, suggesting the development of occlusion due to arterial dissection. Based on these findings, SAM of multiple visceral arteries was diagnosed. Because the patient’s vital condition was stable, treatment by observation, with restriction of daily living, was chosen. Seventy-five days later, the pathological lesions in the affected vessels spontaneously resolved. Conclusions: While coincidence could not be completely excluded in this case, anti-COVID-19 mRNA vaccination should be noted for its potential association with SAM as a possible late complication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Case of Segmental Arterial Mediolysis of Multiple Visceral Arteries Following Anti-COVID-19 Vaccination: Late Complication or Rare Coincidence?

2022

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Vertebral artery dissecting aneurysm rupture under severe COVID-19

Sato

Miura²,

Yasuda³

et al. 2022

Brain Hemorrhages

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Ruptured Cerebral Aneurysms and Dissecting Aneurysms in Patients with COVID-19: A Case Series and Literature Review

Wajima,

Shimozato,

Takeshita

et al. 2023

Indian Journal of Neurosurgery

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Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a hypercoagulable state and ischemic stroke. However, aneurysmal subarachnoid hemorrhage (SAH) due to SARS-CoV-2 infection is uncommon. Here, we report a case series of SAH caused by ruptured cerebral aneurysms or dissecting aneurysms (DAs) in patients with coronavirus disease 2019 (COVID-19) and discuss the potential relationships between them. Case Description Four of the six patients had a history of COVID-19, ranging from 2 to 9 days, one had COVID-19 pneumonia for 1 month, and one had SARS-CoV-2 positivity on admission. Plain head computed tomography revealed diffuse SAH in all cases, while angiography revealed a DA in the right posterior cerebral artery (P2 portion) in patient 1, DA in the right vertebral artery (VA) in patients 2 and 6, anterior communicating artery aneurysm in patient 3, blister aneurysm in the right internal cerebral artery (ICA) (C2 portion) in patient 4, and DAs in the right VA and extracranial portion of the right ICA in patient 5. Treatment comprised internal trapping for patients 1, 2, and 6; neck clipping for patient 3; stent-assisted coiling for patient 4; and internal trapping and flow diversion for patient 5. All the patients' postoperative courses were uneventful. Conclusion The present cases alone do not provide clear evidence on whether SARS-CoV-2 infection causes ruptured cerebral aneurysms or DAs. Therefore, accumulation of more cases and further studies are needed to clarify the relationship between SARS-CoV-2 infection and these aneurysm conditions.

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SARS-CoV-2-related vascular injury: mechanisms, imaging and models

Cited by 4 publications

References 52 publications

A Case of Segmental Arterial Mediolysis of Multiple Visceral Arteries Following Anti-COVID-19 Vaccination: Late Complication or Rare Coincidence?

A Case of Segmental Arterial Mediolysis of Multiple Visceral Arteries Following Anti-COVID-19 Vaccination: Late Complication or Rare Coincidence?

Vertebral artery dissecting aneurysm rupture under severe COVID-19

Ruptured Cerebral Aneurysms and Dissecting Aneurysms in Patients with COVID-19: A Case Series and Literature Review

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