Floating Arterial Thrombus Related Stroke Treated by Intravenous Thrombolysis

Abstract

Background: The effects of intravenous thrombolysis on floating thrombi in cervical and intracranial arteries of acute ischemic stroke patients are unknown. Similarly, the best prevention methods of early recurrences remain controversial. This study aimed to describe the clinical and radiological outcome of thrombolyzed strokes with floating thrombi. Methods: We retrospectively analyzed all thrombolyzed stroke patients in our institution between 2003 and 2010 with floating thrombi on acute CT-angiography before the intravenous thrombolysis. The floating thrombus was diagnosed if an elongated thrombus of at least 5 mm length, completely surrounded by contrast on supra-aortic neck or intracerebral arteries, was present on CT-angiography. Demographics, vascular risk factors, and comorbidities were recorded and stroke etiology was determined after a standardized workup. Repeat arterial imaging was performed by CTA at 24 h or before if clinical worsening was noted and then by Doppler and MRA during the first week and at four months. Results: Of 409 thrombolyzed stroke patients undergoing acute CT Angiography, seven (1.7%) had a floating thrombus; of these seven, six had it in the anterior circulation. Demographics, risk factors and stroke severity of these patients were comparable to the other thrombolyzed patients. After intravenous thrombolysis, the floating thrombi resolved completely at 24 h in four of the patients, whereas one had an early recurrent stroke and one developed progressive worsening. One patient developed early occlusion of the carotid artery with floating thrombus and subsequently a TIA. The two patients with a stable floating thrombus had no clinical recurrences. In the literature, only one of four reported cases were found to have a thrombolysis-related early recurrence. Conclusions: Long-term outcome seemed similar in thrombolyzed patients with floating thrombus, despite a possible increase of very early recurrence. It remains to be established whether acute mechanical thrombectomy could be a safer and more effective treatment to prevent early recurrence. However, intravenous thrombolysis should not be withheld in eligible stroke patients.

Is Unexplained Early Neurological Deterioration After Intravenous Thrombolysis Associated With Thrombus Extension?

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Dl-3-N-butylphthalide attenuates ischemic reperfusion injury by improving the function of cerebral artery and circulation

“…25 Both animal and clinical trials showed a higher risk of thrombosis in the arteries and micro-vessels after stroke, which means the blood vessel could be blocked again and lead to a secondary ischemic brain injury. 22,26 The key point of clinical care is to help recover the blood supply of the ischemic region in time.…”

A Case of Internal Carotid Artery Occlusion Caused by En Bloc Distal Embolization of Carotid Free-Floating Thrombus Treated by Mechanical Thrombectomy

“…They described that IVT may have been related to distal mobilization of the thrombus. 5) Fridman et al reported that the recurrence of ischemic stroke within 24 hours significantly increased in the IVT group compared with that in the non-IVT group. 2) Endovascular treatment of carotid FFT is advantageous in the following points compared with surgical treatment: General anesthesia is not essential, less time is required for the procedure and vascular operation, the risk of embolic complications can be minimized, perioperative anticoagulant therapy can be continued if necessary, and intracranial endovascular treatment can be attempted immediately if a thrombus is carried into the intracranial circulation.…”