Department of Neurology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
PLoS One. 2024 Oct 25;19(10):e0311622. doi: 10.1371/journal.pone.0311622. eCollection 2024.
Acute ischemic stroke (AIS) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to explore neurovascular imaging patterns in patients with SARS-CoV-2-related AIS.
We retrospectively analyzed clinical and radiological data of patients hospitalized with AIS and a positive PCR test for SARS-CoV-2 prior to AIS onset. The control group comprised of AIS patients from a pre-COVID-19 pandemic period matched for gender and age.
Thirty-five SARS-CoV-2-related stroke patients, and 35 controls were included. Fifty-seven percent of SARS-CoV-2 patients had either mild or asymptomatic disease. A distinctive imaging pattern of floating arterial mural thrombus was detected in 5 patients of the SARS-CoV-2 group. In 4 patients thrombus was attached to a stenotic atherosclerotic plaque in the proximal internal carotid artery. In the 5th patient a cardiac CTA showed multiple floating thrombi in the descending aorta. In the control group, floating thrombus was only detected in one patient. Treatment with dual antiplatelet therapy was associated with thrombus dissolution and good clinical outcome. Patients with floating thrombi had a longer time from SARS-CoV-2 diagnosis to stroke onset (mean 7.4 versus 3.4 days).
Floating arterial mural thrombi attached to atherosclerotic plaques are unique characteristic source of AIS in SARS-CoV-2 patients. They may lead to ischemic stroke in patients with mild or asymptomatic infection up to 1-2 weeks from SARS-CoV-2 diagnosis. Patients with embolic AIS and SARS-CoV-2 diagnosis should perform high resolution cranio-cervical vascular imaging to evaluate floating thrombi as a potential embolic source.
急性缺血性脑卒中（AIS）是严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的并发症。我们旨在探索与 SARS-CoV-2 相关的 AIS 患者的神经血管影像学模式。
我们回顾性分析了 AIS 患者的临床和影像学数据，这些患者在 AIS 发病前进行了 SARS-CoV-2 PCR 检测呈阳性。对照组由 COVID-19 大流行前时期的 AIS 患者组成，匹配性别和年龄。
纳入 35 例 SARS-CoV-2 相关脑卒中患者和 35 例对照组。57%的 SARS-CoV-2 患者疾病表现为轻度或无症状。在 SARS-CoV-2 组的 5 例患者中发现了一种独特的浮动脉壁血栓成像模式。在 4 例患者中，血栓附着在近端颈内动脉的狭窄粥样硬化斑块上。在第 5 例患者中，心脏 CTA 显示降主动脉中有多个浮血栓。在对照组中，仅在 1 例患者中检测到浮血栓。双联抗血小板治疗与血栓溶解和良好的临床结局相关。有浮动脉壁血栓的患者从 SARS-CoV-2 诊断到中风发作的时间更长（平均 7.4 天 vs. 3.4 天）。
附着在动脉粥样硬化斑块上的浮动脉壁血栓是 SARS-CoV-2 患者 AIS 的独特特征来源。它们可能导致轻度或无症状感染的患者在 SARS-CoV-2 诊断后 1-2 周内发生缺血性中风。有栓塞性 AIS 和 SARS-CoV-2 诊断的患者应进行高分辨率颅颈血管成像，以评估浮血栓是否为潜在的栓塞源。
