Schinz David, Ploch Marcel, Saleh Andreas, Paprottka Philipp, Laugwitz Karl-Ludwig, Ibrahim Tareq, Berndt-Mück Maria, Riederer Isabelle, Uder Michael, Maegerlein Christian, Kirschke Jan, Zimmer Claus, Boeckh-Behrens Tobias
Department of Neuroradiology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Germany.
Clin Neuroradiol. 2025 Mar 4. doi: 10.1007/s00062-025-01503-w.
Throughout the pandemic, it has become evident that COVID-19 should be recognized as a systemic disease that can affect the coagulation system, potentially resulting in arterial thrombotic events (ATE) with partially bulky free-floating clots. This study aimed to investigate the incidence and imaging characteristics of ATE in hospitalized patients with COVID-19 using clinical and imaging data.
From January 2020 to May 2021, databases of five German tertiary care centers were retrospectively screened for COVID-19 patients with coincidental ATE. ATE were analyzed for localization, time of occurrence, imaging characteristics, and associations with clinical data and laboratory parameters.
Out of 3267 patients, 110 ATE (102 patients, mean age, 72.01 ± 15.64 years; 63 men) were observed in the presence of COVID-19 (3.1%). ATE included ischemic stroke (40%), myocardial infarction (46.4%, %), peripheral infarction (3.6%), thrombi in precerebral arteries (3.6%), mesenteric ischemia (2.7%), thrombi in the aorta (1.8%), splenic infarction (0.9%), and kidney infarction (0.9%). The median time interval between the onset of typical respiratory COVID-19 symptoms and ATE was four days (range, -5-58, negative values indicate ATE prior to symptom onset). A significant percentage of patients exhibited ATEs with an atypical free-floating appearance (10.0%) and multiple occlusions (21.2%).
COVID-19 is a systemic disease associated with ATE in all vascular regions, with a predilection for the heart and brain. The incidence of ATE might be higher than in comparable viral infections and ATE possibly exhibit distinct imaging features rarely seen, such as bulky free-floating clot masses and multiple occlusions. ATE occur most frequently during the first week around the COVID-19 diagnosis.
在整个疫情期间，有一点已变得很明显，即应将新冠病毒感染（COVID-19）视为一种可影响凝血系统的全身性疾病，这可能导致动脉血栓形成事件（ATE），并伴有部分体积较大的游离漂浮血栓。本研究旨在利用临床和影像数据调查COVID-19住院患者中ATE的发生率及影像特征。
对2020年1月至2021年5月期间德国五个三级医疗中心的数据库进行回顾性筛查，以查找合并有ATE的COVID-19患者。对ATE的定位、发生时间、影像特征以及与临床数据和实验室参数的关联进行分析。
在3267例患者中，观察到110例（102例患者，平均年龄72.01±15.64岁；63例男性）合并COVID-19的ATE（发生率3.1%）。ATE包括缺血性卒中（40%）、心肌梗死（46.4%）、外周梗死（3.6%）、脑前动脉血栓（3.6%）、肠系膜缺血（2.7%）、主动脉血栓（1.8%）、脾梗死（0.9%）和肾梗死（0.9%）。典型COVID-19呼吸道症状发作与ATE之间的中位时间间隔为4天（范围为-5至58天，负值表示症状发作前发生的ATE）。相当比例的患者表现出具有非典型游离漂浮外观的ATE（10.0%）和多发闭塞（21.2%）。
COVID-19是一种与所有血管区域的ATE相关的全身性疾病，对心脏和大脑有偏好。ATE的发生率可能高于类似病毒感染，并且ATE可能表现出罕见的独特影像特征，如体积较大的游离漂浮血栓团块和多发闭塞。ATE最常发生在COVID-19诊断后的第一周内。
