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

Tatsuta, Yasuyuki; Ogino, T.; Matsuda, Michihiko; Okamura, Naoyasu; Sakurai, Suguru; Shindo, Koichiro; Kamiyama, Kenji; Osato, Toshiaki; Nakamura, Hirohiko

doi:10.5797/jnet.cr.2021-0008

Cited by 3 publications

(5 citation statements)

References 16 publications

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“…Resolution of FFT without worsening neurological symptoms occurs in 86% of medically treated patients. 3) Nonetheless, recurrent thrombosis 11) or distal embolization of thrombi 12) has also been reported in these patients. In this case, distal embolization was highly likely because the thrombus was giant and had a large volume.…”

Section: Discussionmentioning

confidence: 80%

Mechanical Thrombectomy Using a Large Dual-Layer Stent Retriever for Near-Occlusion of the Common Carotid Bifurcation Caused by a Giant Free-Floating Thrombus

Yokoyama,

Haraguchi,

Ogane

et al. 2023

JNET

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Objective We report a case of near-occlusion of the common carotid bifurcation caused by a giant free-floating thrombus (FFT) successfully treated with mechanical thrombectomy using a large dual-layer stent retriever. Case Presentation A 51-year-old man presented to our hospital with dysarthria, right hemiparalysis, and paresthesia. MRI revealed an acute infarction of the left cortical watershed zone, and MRA revealed decreased signals in the left common carotid bifurcation. Carotid ultrasonography demonstrated a giant FFT in the left common carotid bifurcation. Angiography revealed a giant thrombus extending from the left common carotid artery (CCA) to the internal carotid artery (ICA) and the external carotid artery. As direct aspiration from both a balloon-guided catheter (BGC) and an aspiration catheter (AC) was ineffective, we deployed a large dual-layer stent retriever from the ICA to the CCA with an AC-connected aspiration pump and retrieved it under manual aspiration through the BGC. The giant thrombus was successfully removed, and complete recanalization was achieved without distal embolisms. Conclusion Although there is no established treatment for giant thrombi in the carotid artery, mechanical thrombectomy using a large dual-layer stent retriever may be an effective treatment option.

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Section: Discussionmentioning

confidence: 80%

Mechanical Thrombectomy Using a Large Dual-Layer Stent Retriever for Near-Occlusion of the Common Carotid Bifurcation Caused by a Giant Free-Floating Thrombus

Yokoyama,

Haraguchi,

Ogane

et al. 2023

JNET

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“…However, a therapeutic strategy for acute stroke with carotid FFT has not yet been established. Distal embolization can occur during anticoagulation therapy [5]; additionally, surgery is considered unsafe due to invasive general anesthesia or distal thrombus [6].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, in addition to conventional treatments, endovascular thrombectomy for carotid FFT has been reported [2,4,5,[7][8][9][10][11][12][13][14]. However, when balloon protection is used for distal protection, complete interruption of the ICA flow is undesirable in patients without hemodynamic intolerance.…”

Section: Discussionmentioning

confidence: 99%

Carotid Free-Floating Thrombus Treated With a Combined Technique Using Embotrap III for Distal Protection

Nagao,

Inatomi,

Naganuma

et al. 2024

Cureus

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Carotid free-floating thrombus (FFT) is a rare condition in patients with acute ischemic stroke. Recently, endovascular therapy for carotid FFT has been increasingly reported, but the strategy has not yet been established. We report a case of an acute stroke patient with a carotid FFT, who was successfully treated with a combination of the direct aspiration first-pass technique (ADAPT) and the Embotrap III (Cerenovus, Irvine, CA), specifically designed to prevent distal embolization. We propose the utility of distal embolic protection with Embotrap III for the treatment of patients with carotid FFT. A 71-year-old man who presented with sudden left hemiparesis was admitted to our hospital. Ultrasonography on admission revealed severe stenosis and an FFT at the origin of the right internal carotid artery. Thrombectomy with an aspiration catheter, accompanied by a stent retriever with distal basket Embotrap III for distal protection, was performed. After the FFT was safely aspirated, a carotid Wallstent (Boston Scientific, Marlborough, MA) was deployed in the stenosis. Follow-up ultrasonography showed neither FFT nor in-stent protrusion. The patient did not experience recurrence, as per clinical or radiological findings, and was discharged on day 11 without any neurological deficits. Embotrap III may be useful for a patient with a carotid FFT as distal protection during mechanical thrombectomies.

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“…Successful thrombus retrieval using a stent retriever or aspiration catheter has been reported in cases involving FFT without moderate or severe stenotic lesions. [3,4,8,12] However, few reports have described a combination of mechanical thrombectomy and CAS in cases of carotid artery stenosis with FFT. Tomoyose et al reported a case of FFT attached to severe stenosis of the ICA origin, in which the thrombus was removed by an aspiration catheter after PTA against the stenotic lesion.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stent retrieval for free-floating thrombus attached to carotid artery stenosis: A report of two cases

Yamamoto

Matsuda

et al. 2023

Surgical Neurology International

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Background: We report two cases who underwent mechanical thrombectomy using a stent retriever in advance of urgent carotid artery stenting (CAS) for carotid artery stenosis with free-floating thrombus (FFT). Case Description: Two patients showing symptomatic carotid artery stenosis with FFT underwent urgent endovascular surgery due to progressive neurological symptoms. The first case showed an FFT with 70% internal carotid artery (ICA) stenosis. After the completion of the common and external carotid artery balloon and distal ICA filter protection, we deployed a 6-mm-diameter stent retriever in the distal part of the stenosis. The white thrombus was retrieved; the angiographic shadow of the FFT disappeared; and CAS was performed. In the second case, due to a 90% severe stenosis lesion with FFT, balloon angioplasty was performed on the lesion using the push wire of the stent retriever. After angioplasty, the stent retriever was smoothly retrieved, and CAS was performed. Postoperative magnetic resonance imaging showed an increase in cerebral embolism in the first case; however, the patient’s neurological symptoms improved. The second case showed in-stent plaque protrusion and required two additional stent placements; the patient showed no worsening of his neurological symptoms. Conclusion: In cases of carotid artery stenosis with FFT, it is technically possible to retrieve a thrombus with a stent retriever. Although thrombus removal may help reduce the risk of ischemic complications in a series of urgent CAS procedures, there are concerns such as mechanical irritation to the carotid artery plaque, and its indications and alternative treatments should be carefully considered.

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

Cited by 3 publications

References 16 publications

Mechanical Thrombectomy Using a Large Dual-Layer Stent Retriever for Near-Occlusion of the Common Carotid Bifurcation Caused by a Giant Free-Floating Thrombus

Mechanical Thrombectomy Using a Large Dual-Layer Stent Retriever for Near-Occlusion of the Common Carotid Bifurcation Caused by a Giant Free-Floating Thrombus

Carotid Free-Floating Thrombus Treated With a Combined Technique Using Embotrap III for Distal Protection

Stent retrieval for free-floating thrombus attached to carotid artery stenosis: A report of two cases

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