Clinical and angiographic features of carotid circulationthrombus

Ms, Pessin; Bp, Abbott; Prager, RJ; Ra, Batson; Rm, Scott

doi:10.1212/wnl.36.4.518

Cited by 24 publications

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“…In this study, thrombi disappeared spontaneously with medical treatment on follow-up vascular imaging studies without clinical and imaging evidence of distal migration or stroke. This favorable response has been described in a few other case reports [10,11,12]. Spontaneous lysis of embolized thrombi in the cerebral arteries is frequently observed in acute stroke patients.…”

Section: Discussionsupporting

confidence: 70%

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

Choi

Ahn

et al. 2009

Eur Neurol

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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.

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Section: Discussionsupporting

confidence: 70%

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

Choi

Ahn

et al. 2009

Eur Neurol

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“…Other possible causes of hypercoagulability were not found, aside from an activated platelet function. 7 Therefore, an atheromatous plaque with a mobile component in the aortic arch could be the only embolic source in this patient. Several papers have reported TEE recognition of aortic atheroma as the potential source of embolic stroke.…”

Section: Discussionmentioning

confidence: 81%

Embolic Cerebral Infarction Caused by Intraluminal Thrombus in the Carotid Siphon Successfully Treated With Combination of Anticoagulant and Antiplatelet Drugs

Yamagami

Kitagawa

Ohtsuki³

et al. 2005

Circ J

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ntraluminal thrombus in the carotid artery is identified in less than 3% of patients who undergo cerebral angiography for investigation of ischemic cerebrovascular symptoms. 1,2 Carotid thrombi are usually associated with atherosclerotic stenotic lesions in the carotid bifurcation. To prevent recurrent stroke in these patients, the inhibition of distal embolism must be successful in addition to the resolution of intraluminal thrombus and surgical manipulation for stenotic lesion. The risk of distal embolism can be evaluated as a microembolic signals (MES) in transcranial Doppler (TCD) sonography. 3 Previous studies recommended anticoagulation for the resolution of intraluminal thombus, however, the significance of antiplatelet drugs has been rarely evaluated. 4 We report a patient with recurrent ischemic stroke and retinal artery embolism in whom intraluminal thrombus in the carotid siphon and frequent MES in the middle cerebral artery (MCA) were successfully resolved with combination therapy of anticoagulant and antiplatelet drugs. Circulation Journal Vol.69, September 2005 Case ReportA 54-year-old man experienced right-hand numbness and difficulties with reading and writing in May 2000. A brain computed tomography revealed a low-density area with partial high density in the left parieto-temporal lobe. On admission to hospital in June, the patient's physical examination was normal and neurological examination revealed right-lower quadrantanopsia, slight right hemiparesis and sensory aphasia.Three weeks later, the patient suddenly developed a loss of vision in the left eye and became confused. Funduscopic examinations revealed branch occlusion of the left retinal artery. Laboratory tests showed the following abnormalities: thrombin-antithrombin III complex, 4.48 g/L (normal range, 0-3.0); D-dimer, 1.18 g/ml (0-0.50); -thromboglobulin, 473 ng/ml (<50); and platelet factor-4, 115 ng/ml (<20). Prothrombin time, activated partial thrombin time (APTT), protein S and C, anticardiolipin antibody and lupus anticoagulant were all within normal limits.Diffusion-weighted magnetic resonance imaging (MRI) showed small hyperintensity regions scattered within the left MCA territory (Fig 1A). Magnetic resonance angiography (MRA) revealed intraluminal thrombus in the cavernous portion of the left internal carotid artery (Fig 1C). TCD monitoring detected 53 MES over 30 min in the left MCA. To determine the embolic source, the following examinations were performed and showed normal findings: electrocardiogram (ECG), Holter ECG and transthoracic echocardiography. Carotid ultrasonography showed no atheromatous lesion in the carotid bifurcation. In transesophageal echocardiography (TEE), thrombus in the left atrium or patent foramen ovale was not detected, but an

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“…Some small prospective series report similar effectiveness with heparin (and possibly even better results) as compared to emergency embolectomy. 1,3,4,[6][7][8] These reports differ from this one because (1) they refer to thrombi within the ICA, which may be exposed to different flow dynamics, and (2) most patients in these reports had underlying vessel wall abnormalities. Whether the extrapolation of the observations in these series to this patient would have been appropriate is, at best, uncertain.…”

Section: Discussionmentioning

confidence: 95%

“…1 There are few documented patients with discrete CCA thrombi [1][2][3] and, in all these reports, disease of the underlying wall was present, on which the thrombus was presumed to have formed. The patient in this report is unique because the CCA thrombus was not associated with an underlying wall defect, suggesting that the thrombus was actually an embolus that had become trapped in the CCA.…”

Section: Discussionmentioning

confidence: 99%

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Idiopathic Free-Floating Thrombus of the Common Carotid Artery

Silver

Gulka

Nicolle

et al. 2002

Can. j. neurol. sci.

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The unexpected detection of a common (CCA) or internal (ICA) carotid artery thrombus at angiography or carotid duplex ultrasonography (CUS) is unusual. [1][2][3][4] To our knowledge, no previous documentation of an apparent free-floating thrombus within the CCA alone exists. We report such a phenomenon in a 45-year-old woman. PATIENTA 45-year-old right-handed woman began having severe vomiting and diarrhea. During one of several trips to the bathroom, she was heard falling to the floor, and was found unable to move her right side. She presented to our hospital four hours after symptom onset. She had no recent illnesses and had not been taking any medications including hormone replacement therapy or birth control pills. Cerebrovascular risk factors included a 25-year, one pack per day smoking history and a family history of heart disease and stroke. Her initial vital signs were unremarkable. Her general examination was remarkable for a harsh, ABSTRACT: Background: The observation of an intraluminal common carotid artery thrombus overlying a wall defect at ultrasonography or angiography is unusual. To our knowledge, there are no previous reports of a free-floating thrombus in the common carotid artery. Case Report: A 45-year-old woman who was previously healthy and on no medications presented with acute hemiparesis and aphasia. Following testing that included carotid duplex and trancranial Doppler ultrasonography, diffusion-weighted magnetic resonance imaging, and digital subtraction angiography, the patient underwent emergency open embolectomy. No underlying wall defect was seen at the time of imaging or surgery. No obvious hypercoagulable state could be identified. Her NIH Stroke Scale score improved from 26 at admission to 2 at three months and 1 at one year. Conclusions: Multimodal imaging may have improved diagnosis and management in this patient with a unique finding. The source of the thrombus remains obscure.RÉSUMÉ: Thrombus flottant idiopathique de la carotide primitive. Introduction: Il est inusité d'observer un thrombus intraluminal au niveau d'une lésion de la paroi de la carotide primitive à l'échographie ou à l'angiographie. À notre connaissance, il n'existe pas de cas rapporté d'un thrombus flottant dans la carotide primitive. Histoire de cas: Une femme âgée de 45 ans, en bonne santé et ne prenant aucun médicament, a consulté pour une hémiparésie aiguë avec aphasie. Suite à une investigation comprenant un duplex carotidien, une échograplie Doppler transcrânienne, une résonance magnétique par diffusion pondérée et une angiographie digitalisée par soustraction, la patiente a subi une embolectomie ouverte d'urgence. Aucune lésion pariétale sous-jacente n'a été observée à l'imagerie ou à la chirurgie. Aucun problème d'hypercoagulabilité n'a été identifié. Son score au NIH stroke scale s'est amélioré, de 26 qu'il était à l'admission à 2 trois mois plus tard et à 1 après un an. Conclusions: L'imagerie multimodale a probablement aidé au diagnostic et au traitement de cette patiente porteuse d'une anomalie ...

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Clinical and angiographic features of carotid circulationthrombus

Cited by 24 publications

References 0 publications

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

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

Embolic Cerebral Infarction Caused by Intraluminal Thrombus in the Carotid Siphon Successfully Treated With Combination of Anticoagulant and Antiplatelet Drugs

Idiopathic Free-Floating Thrombus of the Common Carotid Artery

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