Considerations beyond Stenosis for Carotid Endarterectomy in Treating Free-Floating Thrombus of the Carotid Artery

Tolaymat, Besher; Irizarry, Karen; Reif, Michaella M.; Drucker, Charles B.; Aicher, Brittany O.; Sarkar, Rajabrata; Toursavadkohi, Shahab; Monahan, Thomas S.

doi:10.1016/j.avsg.2019.02.024

Cited by 10 publications

(7 citation statements)

References 21 publications

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“…It is proposed that surgery should be performed regardless of the degree of carotid stenosis. 10 In our case, the FFT was extending in the ICA lumen, and the operation was considered risky to provoke thrombus dislodgment and distal intracerebral embolism. We decided to start anticoagulation plus antiplatelet treatment to halt the thrombus progression, offering the opportunity for potential fibrinolysis to take place.…”

Section: Introductionmentioning

confidence: 72%

Free-Floating Thrombus in the Distal Internal Carotid Artery Causing a Stroke

et al. 2020

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We present a patient suffering from a stroke with a free-floating thrombus extending up to the distal internal carotid artery. The thrombus was totally resolved after a 2-week anticoagulation regimen without leaving behind any severe residual stenosis in the carotid bulb. The optimal treatment of this rare condition remains uncertain. We report some important treatment strategies that have been used in the literature, emphasizing the anticoagulation as the mainstay of therapy. Immediate surgical and interventional manipulations carry the risk of thrombus dislodgement and embolization and should be considered if there are recurrent symptoms despite medical management.

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Section: Introductionmentioning

confidence: 72%

Free-Floating Thrombus in the Distal Internal Carotid Artery Causing a Stroke

et al. 2020

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“…However, there is still a 7.5% stroke recurrence rate and a 3.5% mortality rate, with a median event time of 2 days (IQR 1-8 days). Therefore, early identification of medication refractory Some scholars have reported that CEA is safe and effective in the treatment of CFFT (9). There are also reports of CAS in the treatment of CFFT (10).…”

Section: Discussionmentioning

confidence: 99%

Case report: Ultrasound-Assisted endovascular therapy for carotid artery floating thrombus

Wang

Pan

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCarotid free-floating thrombus (CFFT) is a rare but sometimes emergent condition. There has been controversy over the optimal treatment strategy. Emerging evidence suggests that endovascular thrombectomy (EVT) may be an alternative to surgery. Accurate alignment of the aspiration catheter and thrombus during EVT is critical but has, so far, remained unresolved.Case summaryThis is a rare case of CFFT presenting with acute right-sided facial droop and moderate dysarthria in a 77-year-old man. He was in sinus rhythm with a blood pressure of 110/82 mmHg. Both non-contrast CT (NCCT) and head CT angiography (CTA) were unremarkable, while whole-brain CT perfusion (WB-CTP) suggested left hemisphere core infarction. Delayed imaging of the left internal carotid system by 4D-CTA suggested severe proximal obstructive disease, as confirmed by carotid CTA and ultrasonography. The initial two aspirations under DSA were invalid due to the challenging anatomical angle between the thrombus and the catheter. The success of CFFT removal was achieved with a pressure-assisted ultrasound-guided approach that helps to compress the catheter tip toward the thrombus.ConclusionWe innovatively report a successful ultrasound-guided EVT for CFFT. Ultrasound assistance can provide quick and effective guidance and may guide tailored aspirations during EVT.

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“…In most cases, CFFT is symptomatic with a history of ischemic stroke [10]. The rate of stroke in COVID-19 patients is about 1% [11].…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular approach can also be considered in CFFT with stenting, aspiration or reversal of flow [10].…”

Section: Discussionmentioning

confidence: 99%

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

Fatma¹

2022

JSRP

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It is now admitted that Coronavirus is related to vascular complications especially thrombotic ones. Mechanism of thrombotic complications is not fully understood. Free-floating carotid thrombus is a rare condition and it has been found in numerous cases of COVID-19 patients. Data related to management of this floating clot is limited. Anticoagulation remains an important pillar of treatment. We report is this work, a case of a 59-year-old male, hospitalized twice for management of COVID-19 infection in January and March 2021. A free-floating carotid thrombus was discovered and a medical treatment was initiated.

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Considerations beyond Stenosis for Carotid Endarterectomy in Treating Free-Floating Thrombus of the Carotid Artery

Cited by 10 publications

References 21 publications

Free-Floating Thrombus in the Distal Internal Carotid Artery Causing a Stroke

Free-Floating Thrombus in the Distal Internal Carotid Artery Causing a Stroke

Case report: Ultrasound-Assisted endovascular therapy for carotid artery floating thrombus

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

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