Successful treatment of thromboses of major arteries after ChAdOx1 nCov-19 vaccination

Abstract

The ChAdOx1 nCoV-19 adenoviral vector vaccine to prevent contracting Covid-19 caused by infection with SARS-CoV-2 has been associated with vaccine-induced immune thrombotic thrombocytopenia (VITT) primarily leading to venous thromboses. Here, we report two cases of major arterial occlusions after ChAdOx1 nCov-19 vaccination, comprising a 42-year-old woman with thrombotic occlusion of the left carotid artery, and a 62-year-old man with occlusion of distal aorta and iliac arteries. Both were successfully treated with intravenous immunoglobulins and non-heparin anticoagulant agents leading to a beneficial short-term outcome of 6 weeks in case 1 and four months in case 2.

Fig. 1

a Axial T1 fat saturated and b coronal Time Of Flight (TOF) MRI images at 1.5 T show evidence of left intracranial ICA thrombotic occlusion in petrous to clinoid ICA segments. c Axial diffusion weighted (DW) and d Fluid Attenuated Inversion Recovery (FLAIR) images reveal concomitant downstream infarction in MCA territory

Fig. 2

a Coronal and b curved multiplanar reconstructions of CT-A (in 5 mm maximum intensity projection) display subtotal thrombotic occlusion of infrarenal aorta and extension of thrombus into both common iliac arteries and right external iliac artery. c Coronal multiplanar reconstruction of CT-A (5 mm maximum intensity projection) and d magnified image show segmental pulmonary artery embolism