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Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability
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COVID-19-Associated Carotid Atherothrombosis and Stroke

C Esenwa1, N T Cheng2, E Lipsitz3

  • 1From the Department of Neurology (C.E.E., N.T.C., D.A., A.S., K.K., A.L., P.M., T.N., D.R., D.L.) cesenwa@montefiore.org.

AJNR. American Journal of Neuroradiology
|August 22, 2020
PubMed

Insights

Coronavirus disease 2019 (COVID-19) can cause acute ischemic stroke through a novel mechanism of severe carotid artery thrombosis, even with mild underlying atherosclerosis. This COVID-associated carotid atherothrombosis presents a new understanding of stroke risk in COVID-19 patients.

Area of Science:

  • Neurology
  • Cardiology
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) is associated with various neurological complications.
  • Acute ischemic stroke is a recognized but not fully understood complication of COVID-19.

Purpose of the Study:

  • To present a case series of patients with COVID-19 and acute ischemic stroke.
  • To propose a novel mechanism for stroke in COVID-19 patients: COVID-associated carotid atherothrombosis.

Main Methods:

  • Radiology-pathology case series review.
  • Analysis of 3 patients with COVID-19 and acute ischemic stroke.
  • Correlation of imaging findings with pathological evidence of carotid thrombosis.

Main Results:

  • Three patients with COVID-19 presented with acute ischemic stroke.
  • The stroke was attributed to fulminant carotid artery thrombosis.
  • Mild underlying atherosclerotic plaque was noted in the affected carotid arteries.

Conclusions:

  • A novel stroke mechanism, COVID-associated carotid atherothrombosis, is proposed.
  • COVID-19 may directly promote severe carotid thrombosis, leading to ischemic stroke.
  • This finding highlights a specific vascular complication of COVID-19 requiring further investigation.

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