Bakirli Ilkin, Tomka Jan, Pis Marian, Bakirli Hasan, Bakirova Gultakin, Osusky Matej, Gazi Andrej, Bakirov Ifrat
Vascular Surgery, National Institute of Cardiovascular Diseases, Bratislava, SVK.
Vascular Surgery, Slovak Medical University, Bratislava, SVK.
Cureus. 2021 Oct 9;13(10):e18626. doi: 10.7759/cureus.18626. eCollection 2021 Oct.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), was initially discovered in December 2019 in China and rapidly spread all over the world to become a pandemic. The most common symptoms of a disease are fever, cough, generalized body ache, weakness, dyspnoea, nausea, vomiting, and diarrhea. Among vascular complications of COVID-19, the venous thrombotic complications, like pulmonary embolism and lower limb deep veins thrombosis, are not uncommon. But data about arterial thrombotic complications of COVID-19, especially carotid thrombosis, are still limited. We are describing a case of stroke due to thrombosis of the right carotid arteries, in a patient who had recovered from asymptomatic COVID-19. A 66-year-old male with arterial hypertension presented to the emergency department with a history of repeated collapse, dysarthria, weakness in the left extremities, and a drop in the left angle of his mouth (National Institutes of Health Stroke Scale [NIHSS]-4). The patient was swabbed for COVID-19 which was negative. A computed tomography angiography (CTA) was obtained which showed thrombosis in the branching point of the brachiocephalic trunk (BCT) continuing into the right subclavian artery (SA) and also into the right common carotid artery (CCA), with a subtotal occlusion of the right CCA, extending into the internal carotid artery (ICA) as well. From the apical lung tissue caught during the CT scan, bilateral, irregular widespread ground-glass opacifications, as well as consolidations and small reticular changes were seen in the lungs, which is typical for COVID-19 infection. A quantitative antibody test for COVID-19 infection was performed with the results showing a strong positivity for IgG antibodies, indicating previous COVID-19 infection. The patient was indicated for a standard carotid thrombectomy, which was performed without complications. It seems that one of the important factors that led to the formation of the thrombus in the carotid arteries was COVID-19 infection-induced inflammation in the atherosclerotic carotid vessels and generalized hypercoagulability as well as hyperviscosity. COVID-19 infection is an independent and important risk factor for the formation of an arterial thrombus during the acute illness and in the early post-COVID-19 period also, regardless of the severity of its course. Prophylactic anticoagulation is needed not only at the time of acute illness but also at the early post-COVID-19 time.
2019冠状病毒病（COVID-19）由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起，于2019年12月在中国首次发现，并迅速蔓延至全球，成为大流行病。该疾病最常见的症状是发热、咳嗽、全身酸痛、乏力、呼吸困难、恶心、呕吐和腹泻。在COVID-19的血管并发症中，静脉血栓形成并发症，如肺栓塞和下肢深静脉血栓形成并不少见。但关于COVID-19动脉血栓形成并发症的数据，尤其是颈动脉血栓形成的数据仍然有限。我们正在描述一例在无症状COVID-19康复后的患者中，因右颈动脉血栓形成导致中风的病例。一名患有动脉高血压的66岁男性因反复晕厥、构音障碍、左肢无力和左侧口角下垂（美国国立卫生研究院卒中量表[NIHSS]-4）的病史就诊于急诊科。对该患者进行了COVID-19拭子检测，结果为阴性。进行了计算机断层扫描血管造影（CTA），显示头臂干（BCT）分支点处血栓形成，延续至右锁骨下动脉（SA），并延伸至右颈总动脉（CCA），右CCA几乎完全闭塞，也延伸至颈内动脉（ICA）。在CT扫描过程中获取的肺尖组织中，肺部可见双侧不规则广泛的磨玻璃样混浊，以及实变和小网状改变，这是COVID-19感染的典型表现。进行了COVID-19感染的定量抗体检测，结果显示IgG抗体呈强阳性，表明既往感染过COVID-19。该患者接受了标准的颈动脉血栓切除术，手术无并发症。似乎导致颈动脉血栓形成的重要因素之一是COVID-19感染引起的动脉粥样硬化颈动脉血管炎症、全身高凝状态以及高黏滞血症。无论COVID-19病程的严重程度如何，COVID-19感染都是急性疾病期间以及COVID-19后早期动脉血栓形成的独立且重要的危险因素。不仅在急性疾病期间，而且在COVID-19后早期都需要预防性抗凝。
