Endovascular treatment of an internal carotid artery thrombus using reversal of flow: A case report

Abstract

A case of a symptomatic free-floating thrombus of the internal carotid artery is described. A 51-year-old woman presented with a transient ischemic attack and was placed on anticoagulation after diagnosis with angiography. After medical therapy failed, she underwent suction embolectomy using reversal of flow with the Parodi Anti-Embolism System. Balloon angioplasty was performed, and a stent was placed. The patient tolerated the procedure well. A follow-up carotid ultrasound scan showed resolution of the thrombus.

Recurrent Subacute In-stent Restenosis After Carotid Artery Stenting due to Plaque Protrusion -Case Report-

“…19) We selected a closed-cell stent design to prevent plaque shift and distal embolization because the stenosis was considered to be lipid-rich soft Residual stenosis at the distal portion of the stent was dilated using a Gateway balloon catheter (Boston Scientific). Subsequent angiography showed resolution of the stenosis and excellent flow through the intracranial vessel (Fig.…”

Immediate surgery for acute internal carotid artery dissection and thrombosis during filter deployment prior to stenting: a case report

“…The intraluminal manipulation of guidewires and catheters in association with thrombolysis can cause clot fragmentation and subsequently increase the risk of distal vessel occlusion. Parodi et al 12 recently described a case of endovascular treatment of a symptomatic free-floating thrombus of the internal carotid artery with suction embolectomy using a flow reversal antiembolic protection system. This anectodal technique involves less risk of distal embolization in the case of partial internal carotid thrombosis, but to our knowledge, it has never been attempted for total occlusion of the internal carotid artery.…”

Idiopathic floating thrombus of the common carotid artery: Diagnosis and treatment options

“…Angiography, once routine in these cases, is no longer used in this phase of diagnosis because the procedure itself is associated with the risk of ischemic stroke (1.5%), as demonstrated by the Asymptomatic Carotid Atherosclerosis Study on carotid endarterectomy. It appears to be indicated only when the thrombus is going to be treated with an endovascular technique [6].…”

“…In recent years, some groups have proposed the use of protected endovascular stenting [6] with flow reversal (which eliminates the need to pass the protective device through the clot prior to stenting), but it is rarely used because it, too, carries a high risk of embolism due to the inherent instability of these thrombi.…”