Abstract
SUMMARY: Coronavirus disease 2019 (COVID-19) is associated with a severe inflammatory response. Inflammation affects atherosclerotic plaque vulnerability and promotes a thrombogenic environment. We report a series of 6 patients with COVID-19 with acute ischemic stroke due to intraluminal carotid artery thrombus presenting during an 8-day period. Six patients were included (5 men) with a mean age of 65.8 years (range, 55–78 years). COVID-19 was diagnosed by detection of Severe Acute Respiratory Syndrome coronavirus 2 in 5 patients and was presumed due to typical clinical and imaging findings in 1 patient. All patients had vascular risk factors including diabetes (83%), hyperlipidemia (100%), and smoking (17%). Four patients presented with large infarcts with initial NIHSS scores of 24–30. During their hospitalization, all patients had elevated D-dimer and C-reactive protein levels, 5 patients had elevated lactate dehydrogenase and ferritin levels, 3 had elevated interleukin-6 levels, and 2 had elevated troponin levels. Inflammation related to COVID-19 may result in rupture of vulnerable atherosclerotic plaques, resulting in thrombosis and acute ischemic stroke.
ABBREVIATIONS:
- COVID-19
- coronavirus disease 2019
- ICT
- intraluminal carotid artery thrombus
- IL-6
- interleukin-6
- LVO
- large-vessel occlusion
- SARS-CoV-2
- Severe Acute Respiratory Syndrome coronavirus 2
Footnotes
Ali Y. Mohamud and Brent Griffith contributed equally to this work.
Disclosures: Ali Y. Mohamud—UNRELATED: Employment: Henry Ford Health System, Comments: current postgraduate year 2 neurology resident. Mohammed Rehman—UNRELATED: Payment for Lectures Including Service on Speakers Bureaus: Portola Pharmaceuticals, American Academy of Neurology. Daniel Miller—UNRELATED: Payment for Lectures Including Service on Speakers Bureaus: Boston Scientific, BioTelemetry Inc, Comments: 1 engagement each; both unrelated to this topic. Alex Chebl—UNRELATED: Payment for Lectures Including Service on Speakers Bureaus: Medtronic, Comments: speaker 23 months ago.
- © 2020 by American Journal of Neuroradiology
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