DOI: 10.25881/20728255_2022_17_2_107

Authors

Shatravka A.V.

Caliningrad Regional Hospital, Caliningrad

Abstract

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.

References

1. Cheruiyot I, Kipkorir V, Ngure B, et. al. Arterial thrombosis in coronavirus disease 2019 patients: a rapid systematic review. Ann Vasc Surg. 2021; 70: 273-281. doi: 10.1016/j.avsg. 2020.08.087.

2. Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Nerosci. 2020; 11(7): 995-8. doi: 10.1021/ acschemneuro.0c00122.

3. Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med. 2020; 382(17): e38. doi: 10.1056/NEJMc2007575.

4. Giannis D, Ziogas IA, Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol. 2020; 127: 104362. doi: 10.1016/j.jcv.2020.104362.

5. Batrashov VA, Yudaev SS, Zemlyanov AV. Surgical correction of pathological tortuosities of internal carotid arteries: current state of the problem. Bulleten of Pirogov National Medical and Surgical Centre. 2021; 16(6) :61-67. (In Russ). doi: 10.25881/20728255_2021_16_3_61.

6. Chechyotkin AO, Lagoda OV. Nepolnyj tromboz sonnyh arterij pri ostrom ishemicheskom insul’te. Annaly klinicheskoj i eksperimental’noj nevrologii. 2007; 1(3): 19-24. (In Russ).

7. Ferrero E, Ferri M, Viazzo A, et al. Free-Floating Thrombus in the Internal Carotid Artery: Diagnosis and Treatment of 16 Cases in a Single Center. Ann Vasc Surg. 2011; 25(6): 805-812. doi: 10.1016/j.avsg.2011.02.030.

8. Inatomi Y, Mori A, Yonehara T, et al. Mobile thrombi in the cervical carotid artery. Rinsho Shinkeigaku. 2005; 45(10): 711-716.

9. Luk’yanchikov VA, Udodov EV, Polunina NA, et al. Possibilities of surgical correction of internal carotid artery thrombosis in patients with acute ischemic stroke. Russian Sklifosovsky Journal Emergency Medical Care. 2017; 6(2): 110-117. (In Russ). doi: 10.23934/2223- 9022-2017-6-1-110-117.

10. Majstrenko DN, Ivanov AS, Generalov MI, et al. Determination of barometric criteria for rupture of atherosclerotic plaques in the brachiocephalic arteries. Bulletin of the russian military medical academy. 2021; 23(1); 143-152. (In Russ). doi: 10.17816/brmma63631.

11. Dol’ AV, Ivanov DV, Bahmet’ev AS, et al. Boundary conditions at the outlets for numerical modeling of carotid artery hemodynamics. Russian Journal of Biomechanics. 2021; 25(1): 20-31. (In Russ). doi: 10.15593/ RZhBiomeh/ 2021.1.02.

12. Patent RUS №2723741 C1/17.06.2020. Byul. №34. Majstrenko DN, Kossovich LYu, Ivanov DV, et al. Sposob prognozirovaniya embologennogo razryva nestabil’noj karotidnoj ateroskleroticheskoj blyashki. (In Russ). [URL]

13. Patent RUS №2729733 C1/11.08.2020. Byul. №34. Majstrenko DN, Kossovich LYu, Ivanov DV, et al. Sposob prognozirovaniya embologennogo razryva karotidnoj ateroskleroticheskoj blyashki. (In Russ). [URL]

14. Majstrenko DN, Stanzhevskij AA, Kossovich LYu, et al. The effect of hemodynamic factor on the level of tangential stress of the artery wall in the zone of carotid bifurcation. Bulleten of Pirogov National Medical and Surgical Centre. 2020; 15(3 Pt 2): 36-41. (In Russ). doi: 10.25881/ BPNMSC.2020.22.28.008.

15. Krylov VV, Luk’ianchikov VA. Cerebral revascularization for the treatment of patients with acute ischemic stroke. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2014; 114(12 Pt 2): 46-52. (In Russ).

16. Krylov VV, Lemenev VL, Murashko AA, et al. Treatment of patient with atherosclerotic damage of brachiocephalic arteries combined with intracranial aneurysms. Russian journal of neurosurgery. 2013; (2): 80-85. (In Russ). doi: 10.17650/1683-3295-2013-0-2-80-85.

17. Bartoli MA, Squarcioni C, Nicoli F, et al. Early carotid endarterectomy after intravenous thrombolysis for acute ischaemic stroke. Eur J Vasc Endovasc Surg. 2009; 37(5): 512-518. doi:10.1016/ j.ejvs.2008.12.018.

18. Wang A, Mandigo GK, Yim PD, et al. Stroke and mechanical thrombectomy in patients with COVID-19: technical observations and patient characteristics. J Neurointerv Surg. 2020; 12: 648-53. doi: 10.1136/neurintsurg-2020-016220.

19. Ali А. et al. Mechanical thrombectomy of symptomatic carotid stenosis with free-floating thrombus in a patient with COVID-19 using transcarotid artery revascularization. J Vasc Surg Cases Innov Tech. 2021; 7: 725-9. doi: 10.1016/j.jvscit.2021.09.001.

20. Vremennye metodicheskie rekomendacii. Profilaktika, diagnostika i lechenie novoj сoronavirusnoj infekcii (COVID-19). Versiya 15 (22.02.22). (In Russ). [URL]

For citation

Shatravka A.V. Analysis of the results of treatment of symptomatic non-occlusive thrombosis of the common and proximal internal carotid artery in patients with coronavirus infection. Bulletin of Pirogov National Medical & Surgical Center. 2022;2(17):107-113. (In Russ.) https://doi.org/10.25881/20728255_2022_17_2_107