Department of Surgery, Section of Vascular and Endovascular Surgery, Trinity Health Ann Arbor, Ypsilanti, MI, USA.
Vasc Endovascular Surg. 2024 Aug;58(6):659-662. doi: 10.1177/15385744241240543. Epub 2024 Mar 18.
We present a case of an unvaccinated, 43-year-old African American female patient with COVID-19 infection and clinical evidence of a left hemispheric stroke. A non-occlusive thrombus with a radiographic target lesion was identified on computed tomography angiography (CTA). A multi-disciplinary discussion regarding concern for embolization was provided due to its unstable nature, as well as evidence of recent stroke. Given her acute COVID-19 infection, symptomatology, and radiographic findings, it was concluded that the etiology of her stroke appeared most consistent with a hypercoagulable-related embolism rather than an atheroembolic event. The patient underwent left carotid artery thrombectomy with bovine patch angioplasty. Operative findings included: left carotid thrombus, minimal plaque after evacuation of the thrombus, and a small proximal internal carotid artery diameter. Given concern for stenosis with primary repair a bovine pericardial patch angioplasty was performed. We present a paradigm for extracranial carotid thrombectomy with therapeutic anticoagulation for COVID-related spontaneous arterial thrombosis.
我们报告了一例未接种疫苗的 43 岁非裔美国女性 COVID-19 感染患者，其临床证据显示左侧半球卒中。计算机断层血管造影（CTA）显示存在非闭塞性血栓和放射学靶病变。由于其不稳定性质以及近期卒中的证据，多学科讨论了对栓塞的关注。鉴于她的急性 COVID-19 感染、症状和影像学发现，得出的结论是她的卒中病因最符合与高凝相关的栓塞，而不是动脉粥样硬化栓塞事件。患者接受了左颈动脉血栓切除术和牛心包补片血管成形术。手术发现包括：左颈动脉血栓、血栓抽吸后的微小斑块和较小的颈内动脉近端直径。由于对原发性修复的狭窄存在担忧，因此进行了牛心包补片血管成形术。我们提出了一种治疗 COVID 相关自发性动脉血栓形成的颅外颈动脉血栓切除术和抗凝治疗的范例。
