Of COVID mRNA technology based vaccines (Pfizer & Moderna) & links to cerebrovascular complications & catastrophic vaccine-induced immune thrombotic thrombocytopenia syndrome: the plot thickened with
by Paul Alexander
De Michele et al.'s reporting; ischemic stroke can be the symptom onset of vaccine-induced immune thrombotic thrombocytopenia (VITT) or can complicate the course of the disease.
‘as mass vaccination has progressed,… catastrophic cases of thrombosis have occurred in association with thrombocytopenia and antibodies against PF4 (platelet factor 4).
This catastrophic syndrome has been named vaccine-induced immune thrombotic thrombocytopenia.
Rarely, ischemic stroke can be the symptom onset of vaccine-induced immune thrombotic thrombocytopenia or can complicate the course of the disease.’
…Based on the available data from the literature and from our experience, we propose a therapeutic protocol to manage this challenging condition. Finally, we highlight the overlapping pathophysiologic mechanisms of SARS-CoV-2 infection and vaccination leading to thrombosis.’
Radiological findings from patient 7.
Case reported by De Michele et al.109 A, Computed tomography (CT) demonstrated extensive ischemic changes in the bilateral middle cerebral artery (MCA) distribution with general hypodensity and loss of gray-white matter differentiation. CT angiography showed the occlusion of the right internal carotid artery terminus (white arrow in B) and the proximal M1 segment occlusion of the left MCA (white arrow in C); time-to-maximum (D) and mean transit time (E) in CT perfusion showed hypoperfusion without treatable penumbra; pulmonary artery thrombosis (white arrow in F) with pulmonary consolidation in the right lobe (G).
Radiological findings from patient 6.
Case reported by De Michele et al.109 A, Computed tomography (CT) showed hyperdensity in the right middle cerebral artery. The CT angiography revealed proximal M1 segment occlusion of the right middle cerebral artery (MCA; white arrow in B and C); CT perfusion maps showed a large area of mismatch indicating salvageable penumbra (D); digital subtraction angiography confirming a proximal MCA occlusion (F) of the MCA occlusion (white arrow in E); MCA reocclusion on M2 segment 2 h after the procedure, 3-dimensional time-of-flight magnetic resonance imaging (MRI) sequence (white arrow in G), with extensive ischemic penumbra (time to peak map in H and cerebral blood flow in I). Second endovascular recanalization, oblique views showed occlusion of M2 segment (white arrow in J) with reopening of the vessel after the mechanical thrombectomy (K). Fourteen-day MRI follow-up after craniectomy showed the extension of ischemia to superficial and deep right MCA territory (M) with occlusion of right internal carotid artery at postcontrast sequences (yellow circle in L). N, Right portal vein thrombosis (black arrow).