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Published on: February 16, 2022
Clinicopathologic Analysis of COVID-19 Associated Thrombi in the Setting of Large Vessel Occlusion: A Prospective
Faheem Sheriff1, Jonathan Lavezo2, Ryan Floresca3
1Department of Neurology Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine El Paso TX.
Insights
COVID-19 infection is linked to severe strokes from large vessel occlusion. In affected patients, thrombi showed a predominance of red blood cells, suggesting a unique pathology for these strokes.
Area of Science:
- Neurology
- Pathology
- Infectious Diseases
Background:
- Acute ischemic stroke due to large vessel occlusion (LVO) is a severe complication of COVID-19.
- This condition is associated with increased morbidity and mortality.
- The etiopathogenesis of COVID-19-associated LVO stroke requires further definition.
Purpose of the Study:
- To investigate the association between COVID-19 infection and thrombus pathology in large vessel occlusion strokes.
- To elucidate the underlying mechanisms of this atypical stroke presentation.
Main Methods:
- Thrombi were collected during mechanical thrombectomy and analyzed pathologically.
- Pathology included assessment of red blood cell, fibrin, and white blood cell predominance.
- Samples were tested for SARS-CoV-2 using reverse transcription polymerase chain reaction.
Main Results:
- Seven out of 53 analyzed thrombi (3.6%) were from patients positive for SARS-CoV-2.
- COVID-19 positive stroke patients were younger, more likely male, and had red blood cell predominant thrombi.
- A significant association was found between peripheral neutrophil count and white blood cell lysis in the overall cohort.
Conclusions:
- Thrombi from COVID-19 positive stroke patients exhibited red blood cell predominance.
- This finding suggests a distinct pathological mechanism for COVID-19-related LVO strokes.
- Further investigation with immunohistochemical techniques in larger cohorts is warranted.
Background:
Acute ischemic stroke secondary to large vessel occlusion is among the most serious complications associated with COVID-19 infection resulting in worse morbidity and mortality. We sought to study the association between COVID-19 infection and large vessel occlusion thrombus pathology to better define the etiopathogenesis of this atypical cause of stroke.
Methods:
Thrombi were collected during mechanical thrombectomy and stained using hematoxylin and eosin. Blinded analysis of pathology was prospectively performed by a board-certified neuropathologist. Red blood cell, fibrin, and white blood cell predominance was ascertained. Concomitant peripheral blood counts and clinical and imaging data were collected and analyzed. All samples underwent performance of reverse transcription polymerase chain reaction for SARS-CoV2.
Results:
Between January 2020 and February 2022, a total of 952 acute ischemic stroke admissions were seen at the University Medical Center of El Paso, TX. Of these, 195 patients (20.5%) had large vessel occlusions and underwent mechanical thrombectomy and 53 patients had thrombus collected and analyzed. Seven patients (3.6%) tested positive for SARS-CoV2. COVID-19 positive patients were more likely to be younger (mean 57.4 years; P=0.07), male (85.7%; P=0.03), and have red blood cell predominant thrombi (85.7%; P=0.03). There was a statistically significant association between peripheral neutrophil count and white blood cell lysis in the overall cohort (P=0.015), who did not differ according to COVID-19 status.
Conclusion:
Thrombi retrieved from patients who were COVID-19 positive and had stroke demonstrated red blood cell predominance. This finding requires further investigation using appropriate immunohistochemical techniques in a larger cohort of patients.
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