Acute ischaemic stroke secondary to a mobile thrombus in the common carotid artery - case report

Abstract

A mobile thrombus in the carotid arteries is a very rare ultrasonographic finding and is usually diagnosed after a neurological emergency, such as a transient ischemic attack or cerebral infarction. We present the case of a 54-year-old man with vascular risk factors (a heavy smoker, untreated hypertension) who was admitted to the emergency unit with right sided hemiparesis and aphasia. A cerebral CT scan showed a left middle cerebral artery territory infarction. The duplex ultrasound examination revealed mild atherosclerotic changes in the right common and internal carotid arteries, right-sided complete subclavian steal phenomenon and a complicated hypoechoic atherosclerotic plaque in the left common carotid artery with a large mobile thrombus. Due to the high embolization risk, the patient was hospitalised and prescribed Aspirin together with low molecular weight Heparin. We recorded an improvement in the patient's neurological status and the control duplex scan revealed disappearance of the thrombus. The presence of floating thrombus in a patient with clinical and imagistic evidence of stroke is a major therapheutic challenge for the neurologist. The treatment strategies are not standardized and must be individualized, however in our case parenteral anticoagulation proved to be successful.

Extracranial Carotid Atherosclerosis and Acute Ischemic Stroke in a Tertiary Hospital in Burkina Faso

“…Antiplatelet therapy (DAPT) and statin therapy were the main treatments in ischemic stroke due to atherosclerosis, as in our study but in sometimes, aspirin was prescribed together with low molecular weight heparin [43]. According to World Journal of Neuroscience literature, statins may also act on biological markers of plaque instability and reduced the carotid intima media thickness consistently with all statins.…”

Carotid free-floating thrombus treated with apixaban: report of a case and review of literature

“…Although dislodgment and distal embolization of thrombus could explain thrombus disappearance, the absence of clinical and radiological worsening, speak in favor of apixaban-related resolution. Thrombus disappearance has been scarcely documented, with 35 cases reported to date 1,3,5,6,[9][10][11][12][13] (Table 1). Nevertheless, we must acknowledge there are other potential confounding factors, such as prophylactic UFH contribution, which could suggest apixaban was not the sole responsible; yet, until better evidence is available, our case report speaks in favor of direct Xa factor inhibitors as an alternative to UFH and VKA.…”