Beyond the Lungs: A Literature Review of COVID-19's Impact on Carotid Artery Disease and Treatment Challenges in Pandemic Era

Methods: A comprehensive review of the pathophysiological mechanisms linking COVID-19 to carotid artery disease was conducted, with an emphasis on endothelial dysfunction, hypercoagulability, and inflammation. Current evidence on antithrombotic therapies, surgical interventions, and alternative treatments during the pandemic was evaluated. Additionally, data on the impact of vaccination and associated thrombotic events were analyzed to provide a holistic understanding of the challenges in managing carotid artery disease in the context of COVID-19.

Results: COVID-19 exacerbates vascular dysfunction by triggering systemic inflammation, endothelial damage, and a hypercoagulable state, leading to heightened risks of carotid atherothrombosis and ischemic strokes. The pandemic disrupted elective surgical interventions like carotid endarterectomy (CEA), leading to delays in treatment and poorer outcomes. Antiplatelet and anticoagulant therapies remain crucial but require careful balancing due to the increased risk of bleeding and thrombosis in COVID-19 patients. Vaccination significantly reduced COVID-19-related complications but revealed rare cases

of thrombotic events, including vaccine-induced immune thrombotic thrombocytopenia (VITT), necessitating vigilance in postvaccination care.