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Case Reports
. 2021 Jun;31(2):511-514.
doi: 10.1007/s00062-020-00992-1. Epub 2021 Jan 29.

COVID-19-associated Large Vessel Stroke in a 28-year-old Patient : NETs and Platelets Possible Key Players in Acute Thrombus Formation

Tobias Boeckh-Behrens  1 , Daniel Golkowski  2 , Benno Ikenberg  2 , Jürgen Schlegel  3 , Ulrike Protzer  4 , Christian Schulz  5   6 , Julia Novotny  5 , Kornelia Kreiser  7 , Claus Zimmer  7 , Bernhard Hemmer  2   8 , Silke Wunderlich  2
Affiliations
Case Reports

COVID-19-associated Large Vessel Stroke in a 28-year-old Patient : NETs and Platelets Possible Key Players in Acute Thrombus Formation

Tobias Boeckh-Behrens et al. Clin Neuroradiol. 2021 Jun.
No abstract available

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Conflict of interest statement

C. Zimmer disclosed no relevant relationships regarding activities related to the present article. He has served on scientific advisory boards for Philips and Bayer Schering; serves as co-editor on the Advisory Board of Clinical Neuroradiology; has received speaker honoraria from Bayer-Schering and Philips; the institution has received research support and investigator fees for clinical studies from Biogen Idec, Quintiles, MSD Sharp & Dome, Boehringer Ingelheim, Inventive Health Clinical UK Ltd., Advance Cor, Brainsgate, Pfizer, Bayer-Schering, Novartis, Roche, Servier, Penumbra, WCT GmbH, Syngis, SSS International Clinical Research, PPD Germany GmbH, Worldwide Clinical Trials Ltd., Phenox, Covidien, Actelion, Medivation, Medtronic, Harrison Clinical Research, Concentric, Pharmtrace, Reverse Medical Corp., Premier Research Germany Ltd., Surpass Medical Ltd., GlaxoSmithKline, AXON Neuroscience, Bristol-Myers Squibb, Genentech, Acandis, EISAI, NeuroRx, Italfarmaco, Bioclinica, MIAC and IXICO. No patents issued and pending. B. Hemmer reports personal fees from Desitin, Novartis, Allergy Care and TG Therapeutics outside the submitted work. T. Boeckh-Behrens, D. Golkowski, B. Ikenberg, S. Jürgen, U. Protzer, C. Schulz, J. Novotny, K. Kreiser and S. Wunderlich declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Coronal and b axial view of the right common carotid artery (CCA) just before the bifurcation. Arrow small, wall-adherent thrombus. c Corresponding digital subtraction angiography (DSA) image of the semilunar contrast defect representing the wall-adherent thrombus material (arrow). d–i Histological analyses of the extracted thrombus. d Hematoxylin and eosin (HE) staining of platelets with large areas of fresh erythrocyte-rich areas (red), considerable numbers of nucleated immune cells (blue) and partially interspersed, partially aggregated areas of platelets (pink). Bar 100 µm. e Fibrinogen staining of the thrombus showing nearly no fibrin inside the thrombus. Bar 150 µm. f CD31 staining showing almost all pink areas in the HE staining as positive, suggestive of nearly exclusive thrombocyte aggregations with only minimal fibrin proportions. Bar 100 µm. g CD45 staining polymorphonuclear cells (PMNs) shows only a minority of intrathrombus immune cells being lymphocytes suggesting a predominance of PMNs. Bar 50 µm. h Overview image of citrullinated histone H3 positive (CitH3+) neutrophils (Myeloperoxidase [MPO] red; CitH3+ green). Arrowhead on MPO+ neutrophil; arrow on CitH3/MPO+ neutrophil. Nuclei are counterstained with Hoechst (blue). Bar 20 µm. i Detailed view of immunohistochemical staining of CitH3+ neutrophil extracellular trap (MPO, red; citrullinated histone H3, green). Nuclei are counterstained with Hoechst (blue). Extracellular DNA originates from MPO+ neutrophil. Arrow, nucleus; arrowhead, neutrophil extracellular traps (NET) fiber. Bars, 5 µm
See this image and copyright information in PMC

References

    1. Klok FA, Kruip M, van der Meer NJM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis. Thromb Res. 2020 doi: 10.1016/j.thromres.2020.04.041. - DOI - PMC - PubMed
    1. Oxley TJ, Mocco J, Majidi S, et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med. 2020 doi: 10.1056/NEJMc2009787. - DOI - PMC - PubMed
    1. Fridman S, Bullrich MB, Jimenez-Ruiz A, et al. Stroke risk, phenotypes, and death in COVID-19: systematic review and newly reported cases. Neurology. 2020 doi: 10.1212/WNL.0000000000010851. - DOI - PubMed
    1. Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417–1418. doi: 10.1016/S0140-6736(20)30937-5. - DOI - PMC - PubMed
    1. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135(23):2033–40. 10.1182/blood.2020006000. - PMC - PubMed

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