Caliningrad Regional Hospital, Caliningrad
Complications associated with the new coronavirus infection still remain TERRA INCOGNITA. In the available literature there are a small number of articles describing cases of symptomatic non-occlusive thrombosis of the cervical carotid arteries in patients with a new coronavirus infection.
Aim. To analyze the results of surgical treatment of 3 patients with symptomatic non-occlusive thrombosis of the precerebral carotid arteries in patients with a new coronavirus infection in the hyperacute period of ischemic stroke.
Methods. In 2021, 3 patients with non-occlusive thrombosis of the cervical carotid artery with a neurologic symptoms on the lesion side were hospitalized to the Caliningrad Regional Hospital. The level of neurological deficit at the time of examination according to the modified Rankin scale (mRS) — mRS — were 2 scores- in two patients, mRS — 4 scores — in one patient. At the same time, the intracranial arteries were without any signs of thrombosis, hemodynamically significant stenoses. All patients were diagnosed with the current, firstly diagnosed COVID-19, CT-1 in two patients (up to 20% of lung damage), CT-3 in the third patient (60% of both lung damage). After the necessary diagnostics all patients underwent thrombectomy from the cervical carotid arteries on the first day. The fallow-up period was 3 months.
Long-term results were evaluated at an outpatient admission, which included, in addition to a standard examination, performing ultrasound diagmostics of the cervical arteries.
Results. During the first week after surgery, two patients with a level of neurological deficit mRS=2 points had a complete regression of neurological symptoms. In one patient we had a hemorrhagic transformation 24 hours later with a maximum frontal size of up to 25 mm, clinically asymptomatic. Both patients were successfully discharged. Repeated examination after 3 months revealed no neurological symptoms. According to ultrasound diagnostics of the cervical arteries, there were no restenosis, repeated thrombosis. There was no increase in neurological symptoms in the third patient, however, despite therapy, he was died from complications of COVID-19 on the 4th day after surgery.
Conclusion. Carotid thrombectomy due to symptomatic non-occlusive cervica carotid artery thrombosis in patients with a COVID-19 in the hyperacute period of ischemic stroke is feasible, safe and does not lead to the progression of neurological symptoms, prevents potentially life-threatening intracranial embolisms.
Keywords: stroke, stenosis, thrombosis, carotid artery, thrombectomy, endarterectomy, COVID-19.
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