COVID-19 相关游离颈动脉血栓：细胞因子风暴相关免疫血栓形成所致的脑血管病。
Carotid free-floating thrombus in COVID-19: a cerebrovascular disorder of cytokine storm-related immunothrombosis.
机构信息
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy.
出版信息
Neurol Sci. 2023 Jun;44(6):1855-1860. doi: 10.1007/s10072-023-06682-3. Epub 2023 Feb 18.
BACKGROUNDS
Several neurological manifestations, including stroke, have been reported in COVID-19 patients. The putative role of the COVID-19-related hyperinflammatory state in cerebrovascular disorders remains unclear.
METHODS
From March 2020 to September 2021, we searched for patients who exhibited an ischemic stroke related to carotid free-floating thrombus (CFFT) to investigate its incidence and relationship with COVID-19.
RESULTS
Of 853 ischemic strokes referred to our Stroke Centre during the study period, 5.7% (n = 49) were positive for SARS-CoV-2. Six had CFFT, of which two tested positive for SARS-CoV-2 (2/49 = 4.1%), and four did not (4/802 = 0.5%). The former were two middle-aged men suffering from COVID-19 pneumonia. Floating thrombi were promptly extracted by endarterectomy and endovascular thrombectomy, respectively, with no early and long-term complications. Notably, our COVID-19 patients exhibited little or no atherosclerosis burden on CT angiography, markedly elevated D-dimer levels, and extensive thrombus length.
CONCLUSIONS
COVID-19-induced immunothrombosis possibly played a significant pathogenic role in CFFT.
背景
在 COVID-19 患者中已经报道了几种神经系统表现，包括中风。COVID-19 相关的超炎症状态在脑血管疾病中的作用尚不清楚。
方法
从 2020 年 3 月至 2021 年 9 月，我们搜索了表现为与颈动脉游离血栓（CFFT）相关的缺血性中风的患者，以调查其发病率及其与 COVID-19 的关系。
结果
在研究期间，我们中风中心收治的 853 例缺血性中风中，有 5.7%（n=49）的 SARS-CoV-2 检测呈阳性。其中 6 例有 CFFT，其中 2 例 SARS-CoV-2 检测呈阳性（2/49=4.1%），4 例未检测到（4/802=0.5%）。前者是两名患有 COVID-19 肺炎的中年男性。游离血栓分别通过颈动脉内膜切除术和血管内血栓切除术及时取出，没有早期和长期并发症。值得注意的是，我们的 COVID-19 患者在 CT 血管造影上表现出很少或没有动脉粥样硬化负担，显著升高的 D-二聚体水平和广泛的血栓长度。
结论
COVID-19 诱导的免疫血栓形成可能在 CFFT 中起重要的致病作用。
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