• B Lapergue, A Lyoubi, E Meseguer, I Avram, C Denier, L Venditti, A Consoli, A Guedon, E Houdart, D Weisenburger-Lile, M Piotin, B Maier, M Obadia, and T D E Broucker.
• Neurovascular Unit, Interventional Neuroradiology Department, Foch Hospital, Suresnes, France.
• Eur. J. Neurol. 2020 Nov 1; 27 (11): 2308-2311.

Background And PurposeIschaemic stroke has been described in association with COVID-19. Several pathophysiological mechanisms have been suggested, i.e. prothrombotic state, cardiac injury etc. It was sought to assess the potential association between ischaemic stroke associated with SARS-CoV-2 infection and underlying atherosclerotic lesions.MethodsA retrospective analysis of stroke related to large vessel occlusion was conducted amongst patients with SARS-CoV-2 infection and underlying mild atherosclerotic disease, between 19 March and 19 April 2020 in six different stroke centers in the Île-de France area, France.ResultsThe median age was 52 years, median body mass index was 29.5 kg/m2 . All patients displayed previous vascular risk factors such as high blood pressure, diabetes, dyslipidemia or body mass index > 25. The delay between the first respiratory symptoms of COVID-19 and stroke was 11.5 days. At baseline, all had tandem occlusions, i.e. intracerebral and extracerebral thrombus assessed with computed tomography or magnetic resonance imaging. Cases displayed a large thrombus in the cervical carotid artery with underlying mild non-stenosing atheroma, after an etiological workup based on angio-computed tomography or magnetic resonance imaging and/or cervical echography.ConclusionOur study should alert clinicians to scrutinize any new onset of ischaemic stroke during COVID-19 infection, mainly in patients with vascular risk factors or underlying atherosclerotic lesions.© 2020 European Academy of Neurology.

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