Characteristics and the Fate of Intraluminal Thrombus of the Intracranial and Extracranial Cerebral Arteries in Acute Ischemic Stroke Patients

Abstract

Background: The characteristics and fate of intraluminal thrombus (IT), which may incidentally be detected in acute stroke patients, are not well known and the optimal treatment strategy for IT remains controversial. Methods: We have identified patients with IT in either the extracranial or intracranial artery and followed up on their clinical courses and imaging findings. We categorized it based on its morphology and investigated clinical outcomes and fate of IT in those patients. Results: Among 495 patients with acute ischemic stroke, 9 (1.9%, 8 men, age range of 61–84 years) were identified with IT. Patients with IT could be categorized into three groups: a filling defect (4) during digital subtraction angiography (DSA), a stenosis-mimic lesion on DSA (3), and a mobile mass on carotid duplex (2). All patients had follow-up vascular imaging studies. Complete or partial resolution of IT was seen in 8 patients. Four patients developed transient or minor ischemic symptoms, which were potentially related to IT. Stenosis-mimic lesions and IT adjacent to atherosclerotic plaques appeared to be associated with unstable clinical courses. Conclusions: IT can be categorized according to its morphological features. The outcome may depend on the morphology and location of the IT.

Impact of plaque haemorrhage and its age on structural stresses in atherosclerotic plaques of patients with carotid artery disease: an MR imaging-based finite element simulation study

“…Keeping in mind the aetiology of PH, the presence of intraplaque haemorrhage can be considered as a warning sign of the occurrence of intraluminal thrombus (IT) and an indicator of the severity of plaque vulnerability, as shown by various investigators [10,23,24]. In this scenario a detailed biomechanical assessment of interaction between the PH and intrinsic plaque stresses is crucial to the understanding of the extent to which PH weakens the mechanical structure of the plaque by increasing the mechanical stresses within.…”

A Rare Vascular Complication in a COVID-19 Patient: A Case Report of Free-Floating Carotid Thrombus

“…This entity was discovered and described in 1966 by Ehrenfeld. Its occurring in 0,4% of cases in non-COVID-19 patients [2].…”

Intraluminal Thrombus of the Extracranial Cerebral Arteries in Acute Ischemic Stroke: Manifestations, Treatment Strategies, and Outcome

“…[16][17][18] Contrary to the complete occlusion of ICA, ILT, which is almost always symptomatic, can be associated with an increased risk of stroke recurrence if not treated acutely, mainly due to the dislodging of the clot that causes embolism to the brain. 1,2,19 Although the detection and reporting of ILT of the extracranial cerebral arteries is still rare due to its low incidence rate, 14,20 once detected, it is associated with poor outcomes if not treated promptly and appropriately. 1 For this reason, treatment should be considered immediately after diagnosis.…”