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Pensato U, Forlivesi S, Gentile M, Romoli M, Muccioli L, Ambrosi F, Foschini MP, Gallo C, Ballestrazzi MS, Teutonico P, Faggioli G, Gargiulo M, Galluzzo S, Taglialatela F, Simonetti L, Zini A. Carotid free-floating thrombus in COVID-19: a cerebrovascular disorder of cytokine storm-related immunothrombosis. Neurol Sci 2023; 44:1855-1860. [PMID: 36807242 PMCID: PMC9938732 DOI: 10.1007/s10072-023-06682-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/11/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUNDS Several 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. METHODS From 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. RESULTS Of 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. CONCLUSIONS COVID-19-induced immunothrombosis possibly played a significant pathogenic role in CFFT.
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Affiliation(s)
- Umberto Pensato
- grid.6292.f0000 0004 1757 1758Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy ,grid.417728.f0000 0004 1756 8807IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano Milan, Italy
| | - Stefano Forlivesi
- grid.416290.80000 0004 1759 7093IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy
| | - Mauro Gentile
- grid.416290.80000 0004 1759 7093IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy
| | - Michele Romoli
- grid.414682.d0000 0004 1758 8744Neurology and Stroke Unit, Maurizio Bufalini Hospital, Cesena, Italy
| | - Lorenzo Muccioli
- grid.6292.f0000 0004 1757 1758Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Ambrosi
- grid.414405.00000 0004 1784 5501Unit of Anatomic Pathology at Bellaria Hospital, Bologna, Italy
| | - Maria Pia Foschini
- grid.6292.f0000 0004 1757 1758Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy ,grid.414405.00000 0004 1784 5501Unit of Anatomic Pathology at Bellaria Hospital, Bologna, Italy
| | - Carmine Gallo
- grid.414405.00000 0004 1784 5501Unit of Anatomic Pathology at Bellaria Hospital, Bologna, Italy
| | | | - Paolo Teutonico
- grid.412311.4Vascular Surgery Unit, IRCCS Policlinico S. Orsola, Bologna, Italy
| | - Gianluca Faggioli
- grid.412311.4Vascular Surgery Unit, IRCCS Policlinico S. Orsola, Bologna, Italy
| | - Mauro Gargiulo
- grid.412311.4Vascular Surgery Unit, IRCCS Policlinico S. Orsola, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Simone Galluzzo
- grid.416290.80000 0004 1759 7093IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
| | - Francesco Taglialatela
- grid.416290.80000 0004 1759 7093IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
| | - Luigi Simonetti
- grid.416290.80000 0004 1759 7093IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy.
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Vacirca A, Faggioli G, Pini R, Teutonico P, Pilato A, Gargiulo M. Unheralded Lower limb threatening ischemia in a COVID-19 patient. Int J Infect Dis 2020; 96:590-592. [PMID: 32447121 PMCID: PMC7242202 DOI: 10.1016/j.ijid.2020.05.060] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/07/2020] [Accepted: 05/16/2020] [Indexed: 12/14/2022] Open
Abstract
Acute thromboembolic events appear to be frequent in patients with SARS-CoV-2 infection. We report a case of an intubated patient, who developed a threatening lower limb ischemia. Intra-arterial fibrinolysis and intravenous heparin infusion did not lead to complete recanalization of the tibial arteries, which were successfully treated by surgical embolectomy.
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Affiliation(s)
- Andrea Vacirca
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Gianluca Faggioli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Rodolfo Pini
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Paolo Teutonico
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandro Pilato
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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