Large vessel stroke in six patients following SARS‐CoV‐2 infection: a retrospective case study series of acute thrombotic complications on stable underlying atherosclerotic disease. (14th September 2020) - Lapergue, B.
Abstract : Background and purpose: Ischaemic stroke has been described in association with COVID‐19. Several pathophysiological mechanisms have been suggested, i.e. prothrombotic state, cardiac injury etc. It was sought to assess the potential association between ischaemic stroke associated with SARS‐CoV‐2 infection and underlying atherosclerotic lesions. Methods: A retrospective analysis of stroke related to large vessel occlusion was conducted amongst patients with SARS‐CoV‐2 infection and underlying mild atherosclerotic disease, between 19 March and 19 April 2020 in six different stroke centers in the Île‐de France area, France. Results: The median age was 52 years, median body mass index was 29.5 kg/m 2 . All patients displayed previous vascular risk factors such as high blood pressure, diabetes, dyslipidemia or body mass index > 25. The delay between the first respiratory symptoms of COVID‐19 and stroke was 11.5 days. At baseline, all had tandem occlusions, i.e. intracerebral and extracerebral thrombus assessed with computed tomography or magnetic resonance imaging. Cases displayed a large thrombus in the cervical carotid artery with underlying mild non‐stenosing atheroma, after an etiological workup based on angio‐computed tomography or magnetic resonance imaging and/or cervical echography. Conclusion: Our study should alert clinicians to scrutinize any new onset of ischaemic stroke during COVID‐19 infection, mainly in patients with vascular risk factors or underlying atherosclerotic lesions.