Clinical implications of the incidental finding of a free‐floating thrombus in the internal carotid artery

Härtl, Johanna; Mühlau, Mark; Pernpeintner, Verena; Seifert, C.; Kreiser, Kornelia; Schaffer, Christoph J.; Wunderlich, Silke; Ikenberg, Benno

doi:10.1002/jcu.22811

Cited by 2 publications

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References 12 publications

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“…Though MT may cause vessel injury at intra‐ or extracranial sites, for example, carotid artery dissections or vasospasms 9,10 (Figure 1), it is unclear whether ultrasound follow‐up detects these findings and has an additional diagnostic benefit. Given the growing number of patients receiving MT for acute stroke treatment, 2 a better understanding of this topic could help to determine an optimal outpatient sonographic follow‐up regime and to avoid unnecessary examinations including the risk of incidental findings 11 …”

Section: Introductionmentioning

confidence: 99%

Extracranial ultrasound following mechanical thrombectomy in patients with acute stroke

Roesler

Haertl

Wunderlich

et al. 2021

Journal of Neuroimaging

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Background and Purpose Mechanical thrombectomy (MT) is standard care for patients suffering from an ischemic stroke due to a large vessel occlusion. Immediate and follow‐up transcranial ultrasound examinations after MT were shown to have a diagnostic benefit. However, it is unclear whether repeated extracranial ultrasound after MT has an additional diagnostic yield, that is, depicts new findings. Methods Retrospectively, from our prospective database we identified all patients after MT who presented for a follow‐up examination between January 2017 and March 2020 and who had received an ultrasound examination after MT and at follow‐up. Clinical data were extracted from our database. Ultrasound images of all patients were revisited to identify new findings at follow‐up compared to examination after MT. Results Ninety‐one patients were identified appropriate for further analysis, with a mean age of 67.8 ± 16 years. Median National Institute of Health Stroke Scale at admission was 11 ± 8.5 points. At baseline ultrasound, 18 patients (19.8%) had no atherosclerotic alterations and 73 patients (82.2%) had a plaque burden of ≥1 plaque. During follow‐up, in 5 patients (5.5%) a pathological finding presented in first examination evolved dynamically, that is, normalized. Vessel status of all other patients was stable, especially, in no patient a new relevant pathological finding occurred. Conclusions Although sonographic normalization of pathologic findings was observed, pathologic new findings were not detected during follow‐up. This study provides first data for a discussion of the role of ultrasound in a structured stroke care after MT. However, larger studies are required to improve the understanding.

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Section: Introductionmentioning

confidence: 99%

Extracranial ultrasound following mechanical thrombectomy in patients with acute stroke

Roesler

Haertl

Wunderlich

et al. 2021

Journal of Neuroimaging

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A Case of Coincidental Free Floating Thrombus in the Vertebral Artery in a Patient Presenting with an Anterior Circulation Stroke and Literature Review

et al. 2020

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Free-floating thrombus (FFT) is a rare condition with unknown etiology as described by many case reports presented in previous literature. The patients usually present symptomatically while the other few patients remain asymptomatic and are usually discovered incidentally on computed tomography angiography (CTA). Most of the cases reported in the literature are of FFT in the internal carotid artery. We present a 59-year-old female as a case of FFT in the vertebral artery which was coincidently discovered on CTA in a patient initially presenting with an anterior circulation stroke. This case highlights the importance of early contrast-based vascular imaging in patients presenting with large vessel strokes that are cardioembolic in nature and the unique utilization of a direct aspiration first pass technique (ADAPT) for revascularization. Included herein an extensive review of the literature about the decision making in patients with FFT and a devised proposed practical approach to this entity.

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Clinical implications of the incidental finding of a free‐floating thrombus in the internal carotid artery

Cited by 2 publications

References 12 publications

Extracranial ultrasound following mechanical thrombectomy in patients with acute stroke

Extracranial ultrasound following mechanical thrombectomy in patients with acute stroke

A Case of Coincidental Free Floating Thrombus in the Vertebral Artery in a Patient Presenting with an Anterior Circulation Stroke and Literature Review

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