Clinicopathologic Analysis of COVID-19 Associated Thrombi in the Setting of Large Vessel Occlusion: A Prospective Case-Control Study

Authors

• Faheem Sheriff
• Jonathan Lavezo
• Ryan Floresca
• Mohammad Rauf Chaudhury
• Gabriela Colina
• Robert Regenhardt
• Vikas Gupta
• Gustavo Rodriguez
• Alberto Maud

Language

English

Publication Date

9-1-2023

Journal

STROKE: Vascular and Interventional Neurology

DOI

10.1161/SVIN.123.000840

PMID

41583028

PMCID

PMC12778692

PubMedCentral® Posted Date

5-29-2023

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Acute ischemic stroke secondary to large vessel occlusion is among the most serious complications associated with COVID-19 infection resulting in worse morbidity and mortality. We sought to study the association between COVID-19 infection and large vessel occlusion thrombus pathology to better define the etiopathogenesis of this atypical cause of stroke.

Methods: Thrombi were collected during mechanical thrombectomy and stained using hematoxylin and eosin. Blinded analysis of pathology was prospectively performed by a board-certified neuropathologist. Red blood cell, fibrin, and white blood cell predominance was ascertained. Concomitant peripheral blood counts and clinical and imaging data were collected and analyzed. All samples underwent performance of reverse transcription polymerase chain reaction for SARS-CoV2.

Results: Between January 2020 and February 2022, a total of 952 acute ischemic stroke admissions were seen at the University Medical Center of El Paso, TX. Of these, 195 patients (20.5%) had large vessel occlusions and underwent mechanical thrombectomy and 53 patients had thrombus collected and analyzed. Seven patients (3.6%) tested positive for SARS-CoV2. COVID-19 positive patients were more likely to be younger (mean 57.4 years; P=0.07), male (85.7%; P=0.03), and have red blood cell predominant thrombi (85.7%; P=0.03). There was a statistically significant association between peripheral neutrophil count and white blood cell lysis in the overall cohort (P=0.015), who did not differ according to COVID-19 status.

Conclusion: Thrombi retrieved from patients who were COVID-19 positive and had stroke demonstrated red blood cell predominance. This finding requires further investigation using appropriate immunohistochemical techniques in a larger cohort of patients.

Keywords

COVID‐19, large vessel occlusion, pathology, stroke, thrombus

Published Open-Access

yes

Recommended Citation

Sheriff, Faheem; Lavezo, Jonathan; Floresca, Ryan; et al., "Clinicopathologic Analysis of COVID-19 Associated Thrombi in the Setting of Large Vessel Occlusion: A Prospective Case-Control Study" (2023). Faculty, Staff and Student Publications. 3794.
https://digitalcommons.library.tmc.edu/uthmed_docs/3794