Article Figures & Data
Figures
- FIG 1.
Patient 1. A 55-year-old man with COVID-19 and an NIHSS score of 24. A and B, Coronal reformatted and axial images from CT angiography of the head and neck demonstrate an irregular plaque at the left internal carotid artery bifurcation (arrowhead) and nonopacification of the high cervical and petrous (short arrow) left internal carotid artery from tandem occlusion, with reconstitution of the supraclinoid segment (long arrow). C, CT angiography 3 years prior shows moderate focal stenosis of the left paraclinoid ICA (white arrow). D, CT perfusion map shows a large volume of hypoperfusion (time-to-maximum > 6 seconds) involving the left anterior and middle cerebral artery territory and a considerably smaller volume of presumed core infarct (CBF of <30%) in the left parietal region. E, Digital subtraction angiography of the left internal carotid artery demonstrates an eccentric filling defect of the left carotid bifurcation (black arrow) and left ICA occlusion, with recanalization at the level of the left ophthalmic artery from external-to-internal carotid collaterals (double black arrow).
- FIG 2.
Patient 2. A 78-year-old woman with COVID-19 and an NIHSS score of 25. A, CT of the head without contrast demonstrates an evolving ischemic infarct in the left frontoparietal paracentral cortex (dotted circle) with a smaller infarct posteriorly in the left parietal cortex. B–D, Axial, coronal, and curved reformatted images from CT angiography of the head and neck demonstrate an irregular plaque at the left internal carotid artery bifurcation and an intraluminal filling defect (arrow) extending superiorly in the left internal carotid artery, corresponding to ruptured plaque with clot formation.
- FIG 3.
Patient 6. A 67-year-old man presenting with fever and sudden loss of consciousness. A, Axial noncontrast CT of the head demonstrates a hyperdense left MCA branch (arrow) without evidence of acute infarct. B and C, Axial and curved reformatted images from CT angiography of the head and neck demonstrate an intraluminal clot projecting into the left internal carotid artery at the bifurcation (arrows). D, Coronal MIP from CT angiography of the head and neck demonstrates occlusion of the M1 segment of the left MCA. E, Digital subtraction angiography of the left internal carotid artery demonstrates an eccentric filling defect of the left carotid bifurcation (black arrow).
Tables
Patient demographics and stroke clinical details
Pt. No. Age (yr) Sex Days from COVID-19 Sx Onset Initial NIHSS Cervical Occlusion or Near-Occlusion Location Cranial Occlusion Location Atherosclerotic Plaque Location TICI Score mRS LOS (days) 1 55 M 0 24 Left ICA bifurcation Left ICA petrous segment L petrous ICA 2a 4 8 2 78 F 12 25 Left ICA bifurcation None Carotid bulb NA 5 18 3 62 M 0 25 Right ICA bifurcation Right M1 Carotid bulb NA 5 18 4 74 M 14 5 Right ICA bifurcation None Carotid bulb NA 2 8 5 59 M 4 1 Right ICA bifurcation Right M2 None NA 1 2 6 67 M 7 30 Left ICA bifurcation Left M1 Carotid bulb 2b 4 12 Note:—Pt. indicates patient; Sx, symptom; LOS, length of stay; NA, not applicable.
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