Arterial thrombotic complications in COVID-19 patients

Abstract

The coronavirus disease 2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been described to predispose to thrombotic disease in both the venous and arterial circulations. We report four cases of an acute arterial occlusion in COVID-19 patients and literature review on the occurrence of arterial thrombosis in patients with COVID-19. Our findings demonstrate that physicians should be vigilant for signs of thrombotic complications in both hospitalized and new COVID-19 patients.

Keywords: Arterial occlusion; COVID-19; Ischemia; SARS-CoV-2; Thrombosis.

Fig 1

A 50-year-old COVID-19-positive man with no medical history developed acute claudication of the right limb without neurologic deficits 3 days after admission. Computed tomography angiography (CTA) showed short occlusion of the right common iliac artery.

Fig 2

A 55-year-old COVID-19-positive man with a medical history of diabetes with oral metformin use presented with a pale, pulseless left hand without muscle weakness and minimal sensory loss of the fingers. Acquired computed tomography angiography (CTA) imaging showed subclavian artery occlusion. A, Sagittal view. B, Coronal view. C, Axial view.

Fig 3

A 62-year-old COVID-19-positive man presented with right-sided hemiparesis. A-C, Cerebral computed tomography showed (A) a left dense media sign, (B) occlusion on computed tomography angiography (CTA), and (C) corresponding perfusion defect. D, Digital subtraction angiography confirmed an M1 occlusion. E, After intra-arterial thrombectomy, cerebral blood flow was restored (Thrombolysis in Cerebral Infarction grade 2C).