Large vessel stroke in six patients following SARS-CoV-2 infection: a retrospective case study series of acute thrombotic complications on stable underlying atherosclerotic disease.

Background and purpose Ischemic stroke has been described in association with COVID-19. Several pathophysiological mechanisms have been suggested i.e prothrombotic state, cardiac injury etc. We sought to assess the potential association between ischemic stroke associated with SARS-CoV-2 infection and underlying atherosclerotic lesions. Methods We conducted a retrospective analysis of stroke related to large vessel occlusion among patients with SARS-CoV-2 infection and underlying mild atherosclerotic disease. between 03/19 and 04/19, 2020 in six different stroke centers in the Ile-d- France area, France. Results The median age was 52 years, median BMI was 29.5. All patients displayed previous vascular risk factors such as high blood pressure, diabetes, dyslipidemia or BMI >25. The delay between the first respiratory symptoms of COVID-19 and stroke was 11.5 days. At baseline, all had tandem occlusions, i.e intra and extracerebral thrombus assessed with CT or MR imaging. Cases displayed a large thrombus in the cervical carotid artery with underlying mild non stenosing atheroma, after an etiological workup based on angio-CT or MR imaging and/or cervical echography. Conclusion Our study should alert clinicians to scrutinize any new onset of ischemic stroke during COVID-19 infection, mainly in patients with vascular risk factors or underlying atherosclerotic lesions.