Ischemic stroke and floating thrombosis in dissection of the common carotid artery in patient at third week of pregnancy: Surgical technical success and maintenance of pregnancy

Abstract

Thrombosis, especially in pregnancy, is due to a prothrombotic state and involves the venous system. Localization in an arterial segment is rare. Floating carotid arterial thrombosis is a very rare occurrence, but it is very devastating. The authors report the case of a pregnant patient in whom are associated a thrombotic predisposition and a traumatic event of the neck which resulted in a limited dissection and a floating thrombosis of the common carotid artery. The onset was characterized by sudden neurological deficits, including numbness of the right-hand fingers and right limb weakness, which regressed after admission. The patient underwent a surgical operation with success. Her pregnancy continued, and an ultrasound scan 12 months later confirmed the patency of the prosthesis, in the absence of neurological symptoms. Hormonal changes may reveal the condition of thrombophilia, which, however, occurs more frequently in the venous system and is a condition related to the free-floating thrombus. No guidelines exist for medical or surgical management. The endovascular approach appears to present a greater risk of embolization as an alternative to open surgery. This case demonstrates that the prothrombotic state and the presence of neurological symptoms are suggestive of arterial thrombosis in pregnancy and that the multidisciplinary approach is mandatory to achieve good results.

Cervical manipulation and cerebrovascular ischemia. A rare but dangerous association. Monocentric experience in a high CEA volume center and literature review.

“…Dissection of the carotid artery is rarer during chiropractic maneuvers, probably because it is surrounded by soft tissues and less contiguous with the bone planes. For this reason, carotid dissection is presumed to result from compression of the artery against both transverse processes or against the soma of the cervical vertebrae, as in our previous described case [7]. The pharyngeal segment of the internal carotid artery, extending from the carotid bifurcation to its entry into the petrous portion of the temporal bone is less mobile, and therefore more susceptible to injury.…”

“…The prognosis of medical treatment is generally favorable, where it concerns self-limiting lesions. Surgical or endovascular revascularization is reserved for patients with persistent or recurrent symptoms that do not respond to anticoagulant therapy (7) . for medical therapy, there is no evidence from randomized studies (21)(22) to determine whether, in carotid dissections, the use of antiplatelet therapy is superior to anticoagulant therapy.…”