scholarly journals The Common Carotid Artery Thrombus and Embolic Stroke in the Setting of COVID-19 Infection

2021 ◽  
Vol 8 (7) ◽  
pp. 01-03
Author(s):  
Wengui Yu
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Stroke Prevention ◽  
Endothelial Damage ◽  
Embolic Stroke ◽  
Large Vessel ◽  
Secondary Stroke Prevention ◽  
Angiotensin Converting Enzyme 2 ◽  
Vessel Imaging ◽  
Vessel Thrombosis

Since the outbreak of the COVID-19 in Wuhan, China in 2019, there have been increasing reports of large vessel thrombosis and associated embolic stroke in patients with COVID-19 infection. The pathogenesis is thought to be multifactorial, including angiotensin-converting enzyme 2 receptor-mediated endothelial damage, rupture of atherosclerotic plaques, cytokine-storm induced-inflammation, and hypercoagulability. Here, we present a case of an otherwise-healthy COVID-19 patient who developed a right common carotid artery thrombus and embolic stroke with left sided numbness and weakness. Blood tests were significant for elevated levels of inflammatory biomarkers and di-dimer. Vessel imaging showed no evidence of underlying atherosclerosis or arterial dissection. Cardiac workup was unremarkable. The etiology of the carotid artery thrombus was likely COVID-19 related inflammation and hypercoagulability. He was started on apixaban 5mg twice daily for secondary stroke prevention. After 3 months, he was transitioned from apixaban to aspirin 81mg daily. At 4-month follow-up, he improved with only residual left arm numbness. Our case study suggests that in patients with large vessel thrombosis in the setting of Covid-19 infection, oral anticoagulation for 3 months followed by daily aspirin may be a reasonable treatment option for secondary stroke prevention.

Abstract 13293: Detection of Atrial Fibrillation by Implantable Loop Recorders Following Cryptogenic Stroke: A Retrospective Study of Predictive Factors and Outcomes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sara Samaan ◽  
Beshoy Nazeer ◽  
Heidi Stoute ◽  
Wei Zhao ◽  
Susanna Szpunar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Multivariable Analysis ◽  
Cryptogenic Stroke ◽  
Embolic Stroke ◽  
Stroke Recurrence ◽  
Secondary Stroke Prevention ◽  
Recurrence Rates ◽  
Implantable Loop Recorders

Introduction: Cryptogenic strokes account for up to 40% of ischemic strokes. Atrial fibrillation (AF) is a known cause of ischemic stroke. Current data shows that occult AF can be detected by implantable devices at higher rates than conventional cardiac rhythm monitoring. There are, however, limited data available on risk factors and outcomes associated with AF detection by implantable loop recorders (ILRs). Objective: To investigate the risk factors and outcomes associated with occult AF detected by ILR in patients with cryptogenic stroke. Methods: We conducted a retrospective chart review of patients admitted with cryptogenic stroke at Ascension St John Hospital and Ascension Macomb-Oakland Hospital in Michigan who had ILRs placed from 1/1/2016 to 1/31/2020. Data were collected on demographics, comorbidities, treatment and outcomes. AF detection was defined as continuous AF for 30 seconds. Data were analyzed using Student’s t-test, the χ2 test and logistic regression. Results: We reviewed 172 patients, 52.3% male, 56.4% white, mean age 62.7 ± 13.6 years. The incidence of AF detection by ILR was 14% (24/172) over a mean follow-up of 12.75 ± 10.71 months. The mean duration of monitoring prior to AF detection was 4.5 months (range:1 day to 14 months). The median duration of AF was 6 minutes (range: 37.2 seconds to 11.3 hours). From univariable analysis, older age (p=0.03), male sex (p=0.09), embolic stroke pattern on imaging (p=0.06), and lack of AF symptoms (p=0.001) were associated with AF detection by ILR. From multivariable analysis, patients with detected AF were more likely to be older (OR=1.04, p=0.04), male (OR=3.6, p=0.03), asymptomatic (OR=6.3, p=0.01), and have an embolic stroke pattern on imaging (OR=3.3, p=0.04). 95.7% of patients with confirmed AF were started on anticoagulation for secondary stroke prevention. There was no difference in the incidence of stroke post-hospitalization between those with AF detection and those without (16% vs. 16.4%, p=0.96). Conclusions: In patients with cryptogenic stroke, age, gender, stroke pattern, and lack of AF symptoms are independent predictors of occult AF detection by ILR. Most patients with confirmed AF were started on anticoagulation for secondary stroke prevention and had low stroke recurrence rates.

scholarly journals Carotid Artery Imaging for Secondary Stroke Prevention

Stroke ◽  
2009 ◽  
Vol 40 (11) ◽  
pp. 3511-3517 ◽  
Author(s):  
Joanna M. Wardlaw ◽  
Matt D. Stevenson ◽  
Francesca Chappell ◽  
Peter M. Rothwell ◽  
Jonathan Gillard ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stroke Prevention ◽  
Secondary Stroke Prevention

scholarly journals Secondary Stroke Prevention Following Embolic Stroke of Unknown Source in the Absence of Documented Atrial Fibrillation: A Clinical Review

2021 ◽  
Author(s):  
Irum D. Kotadia ◽  
Iain Sim ◽  
Rahul Mukherjee ◽  
Daniel O’Hare ◽  
Amedeo Chiribiri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Structural Changes ◽  
Stroke Risk ◽  
Cryptogenic Stroke ◽  
Embolic Stroke ◽  
Stroke Recurrence ◽  
Secondary Stroke Prevention ◽  
Unknown Source ◽  
The Relationship

Abstract Approximately one‐third of ischemic strokes are classified as cryptogenic strokes. The risk of stroke recurrence in these patients is significantly elevated with up to one‐third of patients with cryptogenic stroke experiencing a further stroke within 10 years. While anticoagulation is the mainstay of treatment for secondary stroke prevention in the context of documented atrial fibrillation (AF), it is estimated that up to 25% of patients with cryptogenic stroke have undiagnosed AF. Furthermore, the historical acceptance of a causal relationship between AF and stroke has recently come under scrutiny, with evidence to suggest that embolic stroke risk may be elevated even in the absence of documented atrial fibrillation attributable to the presence of electrical and structural changes constituting an atrial cardiomyopathy. More recently, the term embolic stroke of unknown source has garnered increasing interest as a subset of patients with cryptogenic stroke in whom a minimum set of diagnostic investigations has been performed, and a nonlacunar infarct highly suspicious of embolic etiology is suspected but in the absence of an identifiable secondary cause of stroke. The ongoing ARCADIA (Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke) randomized trial and ATTICUS (Apixiban for Treatment of Embolic Stroke of Undetermined Source) study seek to further define this novel term. This review summarizes the relationship between AF, embolic stroke, and atrial cardiomyopathy and provides an overview of the clinical relevance of cardiac imaging, electrocardiographic, and serum biomarkers in the assessment of AF and secondary stroke risk. The implications of these findings on therapeutic considerations is considered and gaps in the literature identified as areas for future study in risk stratifying this cohort of patients.

Carotid Artery Stenting for Primary and Secondary Stroke Prevention

2011 ◽  
Vol 76 (6) ◽  
pp. S40-S59 ◽  
Author(s):  
Adnan H. Siddiqui ◽  
Sabareesh K. Natarajan ◽  
L. Nelson Hopkins ◽  
Elad I. Levy
Keyword(s):  
Carotid Artery ◽  
Stroke Prevention ◽  
Carotid Artery Stenting ◽  
Secondary Stroke Prevention

Pretreatment with continuous-wave ultraviolet irradiation to prevent the development of delayed vasospasm in the rabbit common carotid artery model

2000 ◽  
Vol 92 (4) ◽  
pp. 671-675 ◽  
Author(s):  
Kanji Nakai ◽  
Yuji Morimoto ◽  
Kojiro Wada ◽  
Hiroshi Nawashiro ◽  
Katsuji Shima ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Continuous Wave ◽  
Uv Light ◽  
Autologous Blood ◽  
Endothelial Damage ◽  
Terminal Deoxynucleotidyl Transferase ◽  
Content Type ◽  
Irradiation Energy ◽  
Fine Print

Object. Ultraviolet (UV) light irradiation can lead to immunomodulation. The purpose of this study was to determine the preventive effect of UV light on cerebral vasospasm by using a rabbit common carotid artery (CCA) model.Methods. Rabbit CCAs were constricted for a long period by application of autologous blood within a silicon sheath. Before immersion in blood, the CCAs were adventitiously exposed to UV light emitted from a helium—cadmium laser (wavelength 325 nm) yielding an irradiation energy of 10 mJ/mm2. The occurrence of vasospasm was evaluated using angiography 48 hours after blood exposure in this model.The UV light treatment significantly reduced the degree of vasospasm. Compared with luminal diameters measured on Day 0, prior to treatment, the luminal diameters of UV light—treated arteries (six animals) decreased by only 6%, whereas that of the sham-treated arteries (eight animals) significantly decreased by 26% (p < 0.001). Histological examination of UV light—treated CCAs revealed no endothelial damage and extended smooth-muscle cells, in which some fragmented nuclei were confirmed by terminal deoxynucleotidyl transferase—mediated deoxyuridine triphosphate nick-end labeling. Twenty-eight days after blood exposure, examination of UV light—treated CCAs revealed only myointimal proliferation, similar to that of the sham-treated CCAs.Conclusions. These results are the first to provide evidence of a prophylactic effect of UV light on vasospasm and are suggestive of involvement of apoptosis in the mechanism of this effect.

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