COVID-19の頸動脈内血栓。サイトカインの嵐のもう一つの危険？

Intraluminal Carotid Artery Thrombus in COVID-19: Another Danger of Cytokine Storm?

• A Y Mohamud
• B Griffith
• M Rehman
• D Miller
• A Chebl
• S C Patel
• B Howell
• M Kole
• H Marin

抄録

コロナウイルス病2019（COVID-19）は重度の炎症反応と関連している。炎症は動脈硬化性プラークの脆弱性に影響を与え、血栓形成環境を促進する。我々は，8日間の間に頸動脈内血栓を呈して急性虚血性脳梗塞を発症したCOVID-19患者6例のシリーズを報告する．患者は6名（男性5名）で，平均年齢は65.8歳（範囲55～78歳）であった．COVID-19は5人の患者で重症急性呼吸器症候群コロナウイルス2の検出により診断され，1人の患者では典型的な臨床所見と画像所見により推定された．全例に糖尿病（83％），高脂血症（100％），喫煙（17％）を含む血管危険因子を有していた．4人の患者は初期NIHSSスコアが24～30の大梗塞を呈していた。入院中、全例でD-ダイマーとC-反応性蛋白の上昇、5例で乳酸脱水素酵素とフェリチンの上昇、3例でインターロイキン-6の上昇、2例でトロポニンの上昇がみられた。COVID-19に関連した炎症は、脆弱なアテローム性動脈硬化性プラークの破裂を引き起こし、血栓症や急性虚血性脳卒中を引き起こす可能性がある。

Coronavirus disease 2019 (COVID-19) is associated with a severe inflammatory response. Inflammation affects atherosclerotic plaque vulnerability and promotes a thrombogenic environment. We report a series of 6 patients with COVID-19 with acute ischemic stroke due to intraluminal carotid artery thrombus presenting during an 8-day period. Six patients were included (5 men) with a mean age of 65.8 years (range, 55-78 years). COVID-19 was diagnosed by detection of Severe Acute Respiratory Syndrome coronavirus 2 in 5 patients and was presumed due to typical clinical and imaging findings in 1 patient. All patients had vascular risk factors including diabetes (83%), hyperlipidemia (100%), and smoking (17%). Four patients presented with large infarcts with initial NIHSS scores of 24-30. During their hospitalization, all patients had elevated D-dimer and C-reactive protein levels, 5 patients had elevated lactate dehydrogenase and ferritin levels, 3 had elevated interleukin-6 levels, and 2 had elevated troponin levels. Inflammation related to COVID-19 may result in rupture of vulnerable atherosclerotic plaques, resulting in thrombosis and acute ischemic stroke.

© 2020 by American Journal of Neuroradiology.