Disappearance of an Oscillating Intraluminal Thrombus in the Carotid Artery Demonstrated by Ultrasonography

Yonemura, Kensuke; Kimura, Kazumi; Yasaka, Masahiro; Minematsu, Kazuo

doi:10.2169/internalmedicine.42.746

Cited by 12 publications

(7 citation statements)

References 9 publications

(6 reference statements)

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“…Mobile or floating plaque is easily detected by routine carotid ultrasonography and is associated with increased risk of ischemic stroke [11,15,25]. Mobile plaque is thus a form of vulnerable plaque.…”

Section: Introductionmentioning

confidence: 99%

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Vulnerable carotid arterial plaque causing repeated ischemic stroke can be detected with B-mode ultrasonography as a mobile component: Jellyfish sign

Kume¹,

Hama²,

Yamane

et al. 2010

Neurosurg Rev

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Mobile plaque is associated with increased risk of ischemic stroke, but definitions have remained unclear. We have previously reported that carotid ultrasonography can detect the mobile component of the carotid plaque surface, which rises and falls in a manner inconsistent with arterial pulsatile wall motion (Jellyfish sign). However, clinical and pathological features of Jellyfish sign remain unclear. The subjects comprised of 165 patients with carotid plaque and degree of area stenosis ≥50% on ultrasonography. Using magnetic resonance imaging, we quantified intraplaque hemorrhage (IPH) and defined ischemic stroke in each patient. Fifteen surgical specimens were obtained by carotid endarterectomy, and pathological features (area of fibrous cap and intraplaque atheromatous lesion) were compared with ultrasonographic plaque surface movement rate. Carotid plaques with IPH were seen in 78 cases, with Jellyfish sign in 31 cases. Jellyfish sign was not detected in patients without IPH. In these 15 patients, the fibrous cap covered the atheromatous lesion, and cap thickness correlated negatively with Jellyfish-positive plaque surface movement rate. Kaplan-Meier and Cox multiple regression analysis demonstrated that the most important predictor of ischemic stroke during follow-up is Jellyfish sign, not IPH. Stroke events in patients with Jellyfish sign repeated within a short interval after diagnosis. Jellyfish sign on ultrasonography is a sign of high-risk plaque vulnerability, suggesting rupture of the fibrous cap associated with the release of thrombogenic factors into the arterial lumen, and resulting in repeated ischemic stroke during a short interval after diagnosis.

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Section: Introductionmentioning

confidence: 99%

“…Mobile plaque is thus a form of vulnerable plaque. To date, the definition of mobile plaque has been unclear and confused [11,15,25]. We have previously examined mobile plaques from the perspective of the type of motion [12].…”

Section: Introductionmentioning

confidence: 99%

Vulnerable carotid arterial plaque causing repeated ischemic stroke can be detected with B-mode ultrasonography as a mobile component: Jellyfish sign

Kume¹,

Hama²,

Yamane

et al. 2010

Neurosurg Rev

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show abstract

“…There is no consensus of the management protocol for FFT. We summarized the existing literature on this entity in Table 1 [ 3 , 7 , 8 , 12 , 16 - 41 ]. Although it is difficult to establish a consensus on a management approach for FFT, we devised as proposed practical approach to FFT in a decision tree presented in Fig.…”

Section: Discussionmentioning

confidence: 99%

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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“…The prevalence of FFT is described at about 1.5% to 1.6% in stroke or transient ischemic attack (TIA) patients . Carotid artery ultrasonography is not only of importance for a first diagnosis, but furthermore provides an ideal monitoring method . Regarding the prognosis, Fridman et al found a 17.1% risk of TIA, silent brain ischemia, stroke, or death in a 30‐day follow‐up of patients admitted to hospital for acute ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

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

Härtl

Mühlau

Pernpeintner

et al. 2020

J of Clinical Ultrasound

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We present an 81‐year old male in whom a routine carotid artery ultrasonographic follow‐up examination incidentally revealed a large, free‐floating thrombus (FFT) of the right internal carotid artery. This case focuses on the clinical decision‐making regarding FFTs, which constitute a rare condition lacking a diagnostic gold standard with few available data concerning optimum treatment and natural course—in particular regarding patients in whom FFT is an incidental finding. We were able to demonstrate the accuracy of carotid artery ultrasonography in the detection as well as follow‐up of FFT. Of clinical interest is furtherly a possible partial disappearance by spontaneous re‐adhesion or resolution of the FFT.

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Disappearance of an Oscillating Intraluminal Thrombus in the Carotid Artery Demonstrated by Ultrasonography

Cited by 12 publications

References 9 publications

Vulnerable carotid arterial plaque causing repeated ischemic stroke can be detected with B-mode ultrasonography as a mobile component: Jellyfish sign

Vulnerable carotid arterial plaque causing repeated ischemic stroke can be detected with B-mode ultrasonography as a mobile component: Jellyfish sign

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

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

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