Carotid free-floating thrombus in COVID-19: a cerebrovascular disorder of cytokine storm-related immunothrombosis

BackgroundsSeveral 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.MethodsFrom 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.ResultsOf 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.ConclusionsCOVID-19-induced immunothrombosis possibly played a significant pathogenic role in CFFT.

Automated summary

This study investigated the incidence and relationship between carotid free-floating thrombus (CFFT) and COVID-19. Among 853 ischemic stroke patients referred to the Stroke Centre, 5.7% tested positive for SARS-CoV-2. Six patients had CFFT, with two being COVID-19 positive. Prompt extraction of the floating thrombi was conducted with no complications. COVID-19 patients showed little or no atherosclerosis burden but had elevated D-dimer levels and extensive thrombus length. Therefore, COVID-19-induced immunothrombosis potentially played a significant pathogenic role in CFFT.