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Thrombus of the Aorta and SARS-CoV-2 Infection: Cause or Trigger?

Guillaume Goudot1, Mourad Amrane2, Rida El Ayoubi3

  • 1Vascular Medicine Department, Georges Pompidou European Hospital, Institut National de la Sante et de la Recherche Medicale (INSERM) U970 Paris Research Cardiovascular Center (PARCC), Assistance Publique Hopitaux de Paris (APHP), Université de Paris, Paris, France.

Frontiers in Cardiovascular Medicine
|September 23, 2021
PubMed

Insights

Coronavirus disease 19 can cause rare arterial thrombosis. This case highlights plaque erosion as a potential mechanism for aortic arch thrombus formation, leading to stroke.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Pathology

Background:

  • Coronavirus disease 19 (COVID-19) is linked to arterial thrombosis, but mechanisms are unclear.
  • Aortic arch thrombus is a rare but serious complication, potentially causing stroke.

Purpose of the Study:

  • To report a case of large aortic arch thrombus.
  • To describe its surgical management and histological findings.
  • To elucidate the mechanism of thrombus formation in this context.

Main Methods:

  • Computed tomography and echocardiography for thrombus visualization.
  • Surgical aortic arch replacement.
  • Histological analysis of the thrombus and aortic wall.

Main Results:

  • A large, mobile, platelet-rich thrombus was found in the aortic arch.
  • Histology showed thrombus on an atherosclerotic plaque with plaque erosion, not ulceration.
  • Endothelial cell desquamation indicated localized injury.

Conclusions:

  • Plaque erosion, not ulceration, was implicated in thrombus formation.
  • Localized endothelial injury may be the primary driver of thrombus in this COVID-19 case.
  • Surgical intervention was necessary due to stroke risk.

Keywords:
COVID-19aortic archarterial thrombusendothelial dysfunctionplaque erosion

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