Free-Floating Thrombus in the Internal Carotid Artery: Diagnosis and Treatment of 16 Cases in a Single Center

Ferrero, Emanuele; Ferri, Michelangelo; Viazzo, Andrea; Labate, Carmelo; Pecchio, Alberto; Berardi, Giuseppe; Piazza, Salvatore; Cumbo, Pia; Nessi, Franco

doi:10.1016/j.avsg.2011.02.030

Cited by 54 publications

(43 citation statements)

References 29 publications

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“…[1] Mobile floating carotid plaques can be treated with urgent carotid endarterectomy, delayed carotid endarterectomy and carotid angioplasty and stenting. [2,3] Beside surgery, patients are treated with antiplatelet therapy. [2] Neuroimage …”

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confidence: 99%

Mobile floating carotid plaque in a young woman

et al. 2013

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A 32-year-old white woman presented with acute onset of right limb weakness, 3 days before hospitalization. She had non-regulated hyperthyreoidism and a history of smoking. Brain computed tomography (CT) showed a several occipital and high parietal ischemic lesions of the left hemisphere [ Figure 1a and b]. Duplex ultrasonography scan (DUS) showed the existence of fibrolipid plaque located on the back wall of the common carotid artery, that extended to the external as well as internal carotid artery making an uneven plaque, a part of which moved up and down with the heart beat, creating stenosis of 80-90% [ Figure 1c and d]. CT angiography revealed unstable plaque in left internal carotid artery that protrudes into the lumen as well as moderate stenosis in the proximal segment of the external carotid artery [ Figure 2]. She underwent total carotid endarterecotomy of symptomatic left internal carotid artery, 25 days after being admitted. Histopathological finding indicated that the plaque was atherosclerotic. In the prevention of stroke recurrence, the patient was given 75 mg of clopidogrel and 100 mg of aspirin daily. The patient did well, with residual discrete right-sided weakness and no recurrent strokes. Follow-up DUS was done and it showed no signs of plaque or restenosis.Mobile carotid plaques are unstable and associated with recurrent stroke, [1] with the estimated prevalence of 1 in 2000. [2] They bear high risk of embolic cerebrovascular incidents, as was the case in our patient. This type of plaque usually represents degenerated atherosclerotic flap, ruptured plaque with mobile thrombus or intimal dissection plaque. The only method that can show the mobility of the plaque is ultrasonography. [1] Mobile floating carotid plaques can be treated with urgent carotid endarterectomy, delayed carotid endarterectomy and carotid angioplasty and stenting. [2,3] Beside surgery, patients are treated with antiplatelet therapy. [2] Neuroimage Figure 1: Brain computed tomography showed several occipital and high parietal ischaemic leasions of the left hemisphere (a, b). Duplex ultrasonography scan revealed fibrolipid plaque located on the back wall of the common carotid artery, that extended to the external as well as internal carotid artery making an uneven plaque (c, d) d c b a Figure 2: Computed tomographic angiography of the neck showed unstable plaque in left internal carotid artery that protrudes into the lumen as well as moderate stenosis in the proximal segment of external carotid artery. Axial source imaging (a, b) and 3D reconstruction imaging (c, d) d c b a

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confidence: 99%

Mobile floating carotid plaque in a young woman

et al. 2013

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“…A recent single-center retrospective review composed of 16 patients undergoing CEA demonstrated a 30-day survival rate of 93.7 % and symptom improvement in 75 % of patients. The cumulative stroke rate after surgery was 6.3 % (1 out of 16) [9]. Pooled data on FFT surgical treatments have demonstrated a 30-day symptom improvement of 37 % (25 out of 67) with 54 % (36 out of 67) and 9 % (6 out of 67) having no progression or worsening of neurologic symptoms, respectively [7].…”

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confidence: 97%

Computed tomography angiography evaluation of internal carotid artery free-floating thrombus—single-center diagnosis, false-positives, and follow-up

et al. 2012

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“…However, given that CT at a previous hospital performed 3 weeks earlier indicated similar findings, it appears reasonable to conclude that the sensitivity of CT was limited for the detection of free-floating lesions in the bloodstream. In fact, the sensitivity of CT angiography for detection of a free-floating thrombus has been reported to be only 60% (14). Multislice CT may exhibit a better efficacy (15), although this depends on the clinical conditions and the form of the intravascular tumor.…”

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confidence: 99%

Intravenous low-grade endometrial stromal sarcoma with intracardiac extension: A CASE OF inaccurate tumor location on contrast-enhanced computed tomography

Nogami

Yamagami

Maki

et al. 2015

Molecular and Clinical Oncology

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Abstract.We herein report a case of low-grade endometrial stromal sarcoma with intracardiac extension in a 58-year-old woman with a uterine tumor with intravascular involvement. The tumor was suspected preoperatively to be an endometrial stromal sarcoma by magnetic resonance imaging. The extent of intravascular involvement was determined to be below the level of the renal veins on preoperative contrast-enhanced computed tomography (CT). However, perioperative echography revealed that the tumor extended to the right atrium. An emergency cardiotomy with extracorporeal circulation was required. The risk of tumor embolism was reduced through transection of the inferior vena cava, but the tumor was difficult to remove completely. Postoperative hormonal therapy reduced the size of the residual tumor and no recurrence was detected for 1 year. The preoperative contrast-enhanced CT was unable to detect the free-floating intravascular tumor. This case illustrates a limitation of CT and indicates that accurate determination of the tumor extent for planning a surgical strategy in similar cases should be performed using multiple imaging methods.

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Free-Floating Thrombus in the Internal Carotid Artery: Diagnosis and Treatment of 16 Cases in a Single Center

Cited by 54 publications

References 29 publications

Mobile floating carotid plaque in a young woman

Mobile floating carotid plaque in a young woman

Computed tomography angiography evaluation of internal carotid artery free-floating thrombus—single-center diagnosis, false-positives, and follow-up

Intravenous low-grade endometrial stromal sarcoma with intracardiac extension: A CASE OF inaccurate tumor location on contrast-enhanced computed tomography

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