Surgery after Anticoagulation in Stroke Patients with Nonatherosclerotic Internal Carotid Artery Thrombus: A Clinicopathological Case Series

Free‐floating thrombus in stroke patients with nonstenotic internal carotid artery—An ultrasonographic study

“…The incidence of FFT in stroke patients without ICA stenosis was 0.18% in the present study, which is consistent with the results of Bösel et al, who reported a 0.3% incidence of thrombus formation in ICAs without atherosclerotic lesions.…”

Resolution of Occlusive Carotid Artery Thrombus Treated with Anticoagulation as Demonstrated on Duplex Ultrasonography

“…Aside from being used to elucidate imaging findings of other modalities in a noninvasive way, duplex ultrasonography might be useful in patients with characteristics concerning for nonatherosclerotic thrombi. Bösel et al in their series of nonatherosclerotic carotid thrombi managed surgically have suggested that patients with nonatherosclerotic carotid thrombi are typically younger, lack the most common vascular risk factors and atherosclerosis, have a thrombogenic predisposition, and present with minor strokes or TIAs . Given that patients with nonatherosclerotic carotid thrombi often present without typical vascular risk factors, thorough investigation of the possible underlying mechanism for thrombus formation must be undertaken.…”

“…However, occasionally carotid occlusions are identified in patients without significant carotid atherosclerosis. The exact incidence of nonatherosclerotic thrombi is not known, but rates from .05‐.5% have been cited in the literature . In the North American Symptomatic Carotid Endarterectomy (NASCET) trial, intraluminal carotid artery thrombus occurred in 1.1% of patients with <70% stenosis .…”

“…In the North American Symptomatic Carotid Endarterectomy (NASCET) trial, intraluminal carotid artery thrombus occurred in 1.1% of patients with <70% stenosis . At times these nonatherosclerotic carotid thrombi are found to be associated with a hypercoaguable states or inflammatory disorders . The optimal management for nonatherosclerotic occlusive thrombi remains controversial, but has included antiplatelet or anticoagulant with or without delayed revascularization as well as urgent revasculation …”

“…Surgical management of occlusive thrombi carries the potential risk of stroke from thrombus dislodgement. The absolute risk of stroke in patients with nonatherosclerotic carotid thrombi undergoing intervention is not known, given the infrequency with which these procedures occur . However, in patients with atherosclerotic carotid disease, endarterectomy and stenting are both associated with periprocedural complicatrions .…”