We present a case of an unvaccinated, 43-year-old African American female patient with COVID-19 infection and clinical evidence of a left hemispheric stroke. A non-occlusive thrombus with a radiographic target lesion was identified on computed tomography angiography (CTA). A multi-disciplinary discussion regarding concern for embolization was provided due to its unstable nature, as well as evidence of recent stroke. Given her acute COVID-19 infection, symptomatology, and radiographic findings, it was concluded that the etiology of her stroke appeared most consistent with a hypercoagulable-related embolism rather than an atheroembolic event. The patient underwent left carotid artery thrombectomy with bovine patch angioplasty. Operative findings included: left carotid thrombus, minimal plaque after evacuation of the thrombus, and a small proximal internal carotid artery diameter. Given concern for stenosis with primary repair a bovine pericardial patch angioplasty was performed. We present a paradigm for extracranial carotid thrombectomy with therapeutic anticoagulation for COVID-related spontaneous arterial thrombosis.

中文翻译：

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COVID-19 感染患者出现不稳定颈动脉血栓

我们介绍了一名未接种疫苗的 43 岁非裔美国女性患者，她患有 COVID-19 感染，并有左半球中风的临床证据。计算机断层扫描血管造影 (CTA) 发现具有放射学目标病变的非闭塞性血栓。由于栓塞的不稳定性质以及近期中风的证据，对栓塞的关注进行了多学科讨论。鉴于她的急性 COVID-19 感染、症状和放射学检查结果，得出的结论是，她中风的病因似乎与高凝相关栓塞而不是动脉粥样硬化事件最为一致。该患者接受了左颈动脉血栓切除术和牛补片血管成形术。手术结果包括：左颈动脉血栓、血栓清除后斑块极少、近端颈内动脉直径较小。考虑到初次修复引起的狭窄，进行了牛心包补片血管成形术。我们提出了一种针对新冠病毒相关自发性动脉血栓形成的颅外颈动脉血栓切除术和抗凝治疗的范例。