Key result
Three-month anticoagulation resolves a floating aortic arch thrombus in a COVID-19 ischemic stroke case.
Why the study?
COVID-19 is associated with thrombosis, but only a limited number of cases associated with aortic thrombosis have been reported in the literature.
Case Report (n=1)
No
Anticoagulant therapy successfully resolved an incidentally detected floating aortic arch thrombus in a COVID-19 patient presenting with acute ischemic stroke.
May support anticoagulation for floating aortic thrombi in COVID-19 stroke; hypothesis-generating and requires prospective confirmation before practice change.
Introduction: Aortic thrombosis is an uncommon condition with serious embolic complications. COVID-19 is currently recognized to be associated with both venous and arterial thrombosis. However, only a limited number of COVID-19 cases associated with aortic thrombosis have been reported in the literature since the beginning of the pandemic. Case presentation: A 66-year-old lady was admitted to our hospital with acute ischemic stroke. Floating aortic arch thrombus was detected incidentally on CT imaging. Interestingly, the patient reported a history of fever and cough and was found to have COVID-19 pneumonia based on nasopharyngeal polymerase chain reaction (PCR) and imaging. The patient received three months of anticoagulant therapy, and repeated imaging study did not reveal any aortic thrombus. Clinical discussion: COVID-19 related aortic thrombosis has been reported chiefly in severe cases. The SARS-CoV-2 can directly infect the endothelium of the vessels, which might explain the occurrence of arterial thrombosis in milder COVID-19 cases with the absence of the hyperinflammatory state. The management guideline for aortic thrombosis is scarce and based only on case reports and series. Conclusion: Aortic thrombosis is a devastating condition that can be easily missed without clinical suspicion. Our patient developed acute ischemic stroke, most likely embolic originating from the aortic thrombus. The clinician should consider this condition in any COVID-19 patient presenting with thromboembolic events, such as stroke or acute limb ischemia. Further study is required to explain the pathophysiology of arterial/venous thrombosis in mild-moderate COVID-19 cases. HIGHLIGHTS Aortic thrombosis is a rare condition with serious embolic complications. COVID-19 is an emerging condition associated with both venous and arterial thrombo-embolic events. A limited number of COVID-19 cases associated with aortic thrombosis have been reported in the literature. Computed tomography (CT) of aorta should be considered in the evaluation of stroke in COVID-19 patients to rule out aortic thrombo-embolism. The management guidelines of aortic thrombosis are controversial, and based mainly on case reports and series
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Al‐Mashdali et al. (2021) conducted a case report in COVID-19 with aortic arch thrombosis and acute ischemic stroke (n=1). Anticoagulant therapy was evaluated on Resolution of aortic thrombus. A 3-month course of anticoagulant therapy successfully resolved a floating aortic arch thrombus in a 66-year-old woman with mild-moderate COVID-19 who presented with an acute ischemic stroke.
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