Intraluminal carotid thrombosis and acute ischemic stroke associated with COVID-19

Background: Intraluminal carotid thrombi (ILT) are uncommon and present in only 0 4 to 1 5 % of patients with stroke The endothelial inflammation and hypercoagulable state associated with COVID-19 (caused by SARS-CoV-2) poses a risk of arterial and venous thromboembolism Herein, we present a series of stroke patients with ILT in the setting of a recent SARS-CoV-2 infection Methods and Results: From July 9 , 2020 to August 17 , 2020, four patients were identified with acute ischemic stroke with varying thrombus burden but similar morphological patterns of ILT All patients had evidence of recent SARS-CoV-2 infection as confirmed by PCR (n=3) or IgG antibody (n=1) in addition to clinical and radiological manifestations consistent with COVID-19 General characteristics and imaging of the patients are shown in table 1 Mean age was 55 3 ±7 7 years Most patients (3) had at least two vascular risk factors and none had a central embolic source other than ILT D-Dimer was profoundly elevated in 3 patients ILT involved the cervical (3) and intracranial (1) internal carotid artery COVID-19 symptoms ranged from mild transient respiratory symptoms to severe pneumonia requiring critical care support None of the patients received acute reperfusion therapy either due to presentation beyond the therapeutic window or due to the absence of large vessel occlusion and/or unfavorable imaging profile Conclusion: In this small case series of relatively young patients with acute ischemic stroke we found an association between COVID-19 infection and ILT This suggests a distinctive pathophysiological pattern of stroke in COVID-19 patients Further studies are necessary to elucidate the underlying pathophysiology and target specific treatment modalities (Figure Presented)