ABSTRACT NUMBER: ESOC2026A2092 A CASE OF BILATERAL CAROTID DISSECTION DUE TO SARS-COV-2 INFECTION

Abstract Background and aims Causes of cervical arterial dissection include minor trauma and other triggers, genetics, connective tissue or vascular disorders and other conditions. In particular, recent infections such as Sars-CoV-2 should not be overlooked as we know the role viral illnesses play in arterial dissection either directly through viral replication or indirectly through autoimmune or proinflammatory cascades. Methods We described the case of a 44-years-old COVID-19 woman without any antecedent causes nor a positive genetic test with a bilateral dissection of the extracranial segment of the internal carotid artery detected by CT angiography initially symptomatic for head and neck pain and subsequently for local compressive symptoms on the right side and treated conservatively. Results The infectious hypothesis was the most likely given the concomitant Sars-CoV-2 infection. The proposed pathophysiological mechanism involves exacerbation of endothelial dysfunction by the inflammatory response triggered by the virus binding to angiotensin II-converting enzyme receptors resulting in endothelial inflammation and, consequently, arterial dissection. This secondary endothelial damage, along with the cytokine storm and microthrombosis, underlies the hypercoagulable state that characterizes Sars-CoV-2 infection. Furthermore, it is hypothesized that a causal factor for spontaneius dissection in an already weakened arterial wall may be the high-dose corticosteroid therapy commonly used to treat COVID-19. Conclusions Although the alternative hypothesis of a casual association must be considered the case highlights the importance of considering cervical artery dissection as a potential complication of Sars-CoV-2 infections. Conflict of interest Camilla Gaiga: nothing to disclose. Simone Lorenzut: nothing to disclose. Francesco Janes: nothing to disclose. Mariarosaria Valente: nothing to disclose. Giovanni Merlino: nothing to disclose.