Vessel Wall Magnetic Resonance Imaging in Covid-19 associated Cryptogenic Ischemic Stroke.

Mazzacane, Federico; Zito, Antonio; Magno, Serena; Persico, Alessandra; Mazzoleni, Valentina; Asteggiano, Carlo; Rognone, Elisa; Pichiecchio, Anna; Padovani, Alessandro; Cavallini, Anna; Morotti, Andrea

BACKGROUND Acute ischemic stroke (AIS) is a common complication of coronavirus disease 19 (COVID-19) but the underlying biological mechanisms remain unclear. We aimed to describe the prevalence of vessel wall alterations in patients with cryptogenic stroke through vessel wall magnetic resonance imaging (vwMRI). METHODS All consecutive patients admitted for AIS and COVID-19 to a single NeuroCovid unit from November 10th to December 31st, 2020, were prospectively evaluated and underwent a complete etiologic workup for AIS. In patients with cryptogenic stroke, the diagnostic workup was completed with vwMRI study. RESULTS After the exclusion of 4 patients ineligible for MRI, a total of 10 patients were included (median age 78, 50 % males), of whom 4 (40%) had a cryptogenic stroke. vwMRI showed vascular changes consistent with inflammation of intracranial arteries wall in 3 subjects (75%). Two patients had focal and one multifocal involvement. CONCLUSIONS vwMRI detected signs of vascular inflammation in the majority of patients with cryptogenic AIS, leading to an etiologic definition with potential therapeutical implications. Our findings are best interpreted as hypothesis generating, suggesting the possibility to expand the diagnostic workup of cryptogenic stroke with vessel wall imaging.