EugeneFan Profile picture
Sep 25 6 tweets 3 min read Twitter logo Read on Twitter
Our latest STH article "Post COVID-19 Large Vessel Vasculopathy in a Previously Healthy Young Male"
🔬🧑‍🔬We discovered significant damage and scarring of arterial walls - less than 2 years after COVID-19 infection in a healthy, 35 year old male #LongCovid thieme-connect.com/products/ejour…

(D) Emboli from the common femoral artery (CFA)/profunda and superficial femoral artery.
(B) Computed tomography aortogram performed on second admission (15 months from the first episode of acute ischemic limb) showing extensive irregular aortic wall filling defects and stenosis (white arrow)
👉Our patient had post acute sequelae of COVID-19, suffering from recurrent thrombosis/acute ischaemic limb
👉Extensive fibrosis, accumulation of fibromyxoid material was found within the walls of a femoral arterial biopsy
👉This is likely from persistent endothelial dysfunction
(B) HE x 4: expansion of the media by accumulation of hyaline/myxoid material with fragmentation of the smooth muscle layers. There is also extensive transmural fibrosis.
(D) HE X 10: higher power showing expansion of the media by hyaline/myxoid material. Angiogenesis is present in the media.
👨🏻‍⚕️Evidence for this persistent endothelial dysfunction, inflammation, and hypercoagulability can be found in some Covid-19 survivors, as shown by our study in Singapore 🇸🇬 onlinelibrary.wiley.com/doi/10.1002/aj…
Work by our COVID-19 Clotting and Bleeding Investigators team found that platelet hyperactivation was seen in a group of our Covid-19 survivors who experienced a spectrum of illness, from asymptomatic Covid to the critically ill requiring ICU care thieme-connect.com/products/ejour…
Early in the pandemic (2020), we managed young patients who presented with delayed, catastrophic stroke and heart attacks - these patients had thrombotic events weeks to months after their initial COVID-19 infection 🏥 link.springer.com/article/10.100…

a-d Acute magnetic resonance brain images of the 2 patients with large vessel ischaemic stroke. They show large areas of restricted diffusion in left middle cerebral, and middle cerebral, posterior cerebral artery territories, respectively. Adjoining intracranial magnetic resonance angiograms show loss of normal flow void in the left internal carotid and middle cerebral arteries in the first patient (a, b), and M1 segment of left middle cerebral artery in the second patient (c, d)
a Coronary angiogram showed complete occlusion of ostial left anterior descending artery (LAD). Left circumflex artery and ramus intermedius branch are normal. b Restoration of flow in the LAD after implantation of drug eluting stent. c Intravascular ultrasound (virtual histology) showed predominantly fibrotic plaque with minimal necrotic core in the ostial LAD
🚨Endothelial dysfunction remains the cornerstone in post-COVID-19-associated thrombosis, where chronic dysregulation of the endothelium can foster large vessel vasculopathy, even in previously healthy patients. thieme-connect.com/products/ejour…

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