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Intraluminal carotid thrombosis and acute ischemic stroke associated with COVID-19

Diaa Hamouda1, Dinesh V Jillella2, Nirav Bhatt1

  • 1Department of Neurology, Emory University School of Medicine and Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA.

Journal of Neurology
|April 29, 2021
PubMed

Insights

Coronavirus disease 2019 (COVID-19) can cause neurological issues, including stroke. This study examines intraluminal carotid thrombi (ILT) in COVID-19 patients, noting their occurrence without typical atherosclerosis.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Vascular Medicine

Background:

  • COVID-19 presents with varied neurological complications, including stroke.
  • Intraluminal carotid thrombi (ILT) are rare in acute ischemic stroke, typically linked to atherosclerosis.
  • COVID-19 patients show ILT without significant atherosclerosis, suggesting a novel link.

Purpose of the Study:

  • To investigate the occurrence and characteristics of intraluminal carotid thrombi (ILT) in patients with recent SARS-CoV-2 infection.
  • To explore the potential role of COVID-19-associated endothelial inflammation and hypercoagulability in ILT formation.

Main Methods:

  • Case series presentation.
  • Review of clinical data and imaging findings of ischemic stroke patients with carotid ILT.
  • Analysis of patient history for recent SARS-CoV-2 infection.

Main Results:

  • A series of ischemic stroke patients with carotid ILT were identified in the context of recent SARS-CoV-2 infection.
  • These patients often lacked the typical underlying atherosclerotic disease associated with ILT.
  • COVID-19-related hypercoagulability may contribute to ILT formation.

Conclusions:

  • COVID-19 is associated with intraluminal carotid thrombi (ILT) in ischemic stroke patients, even without significant atherosclerosis.
  • The pathophysiology and optimal management of ILT in COVID-19 require further investigation.
  • SARS-CoV-2 infection may promote arterial thromboembolism leading to ILT.

Keywords:
Acute strokeCOVID-19Carotid thrombusIntraluminal thrombusIschemic stroke

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