Ischaemic stroke has been described in association with COVID‐19. There were several pathophysiological mechanisms suggested, i.e., prothrombotic state, cardiac injury, etc. This study assessed the potential association between ischaemic stroke associated with SARS‐CoV‐2 infection and underlying atherosclerotic lesions.

This study was a retrospective analysis of stroke-related to large vessel occlusion among patients with SARS‐CoV‐2 infection and underlying mild atherosclerotic disease in six different stroke centers.

All patients displayed previous vascular risk factors such as high blood pressure, diabetes, dyslipidemia, or body mass index greater than 25. The researchers observed a delay between the first respiratory symptoms of COVID‐19. All of the patients had tandem occlusions, i.e., intracerebral and extracerebral thrombus, assessed with computed tomography or magnetic resonance imaging. Cases displayed a large thrombus in the cervical carotid artery with underlying mild non‐stenosing atheroma after an etiological workup based on angio‐computed tomography or magnetic resonance imaging and cervical echography.

This study alerts clinicians through its findings to scrutinize any new onset of ischaemic stroke during COVID‐19 infection, mainly in patients with vascular risk factors or underlying atherosclerotic lesions.