COVID-19-associated ischemic stroke accompanied by chronic cerebral ischemia due to bilateral internal carotid artery stenoses combined with cerebral aneurysm. A case of simultaneous microsurgical treatment

The case of successful treatment of a patient who underwent COVID-19-associated acute ischemic stroke against the background of combined vascular pathology in the form of hemodynamically significant stenoses of extracranial sections of both internal carotid arteries and saccular aneurysm of the M1 segment of the right middle cerebral artery bifurcation is described. The technique of simultaneous microsurgical treatment of aneurysm and stenosis from the ipsilateral side followed by microsurgical reconstruction of the stenosed carotid artery from the contralateral side was applied. Clinical and functional outcomes were positive: reconstruction of internal carotid arteries on both sides and aneurysm clipping without intra- and postoperative ischemic and hemorrhagic complications were achieved. Immunohistochemical study of the removed atherosclerotic plaques revealed positive expression of S-protein antigen of SARS-CoV-2 localized in fibroblasts and smooth muscle cells, as well as in macrophages infiltrating the plaque.