Symptomatic patients with intraluminal carotid artery thrombus: outcome with a strategy of initial anticoagulation

Abstract

Background Optimal treatment for patients with symptomatic intraluminal carotid thrombus (ICT) remains poorly defined. Methods We performed a retrospective chart review of patients presenting to our institution between 2001 and 2011 with symptomatic ICT. Results Twenty-four patients (16 males, 8 females) with ICT presented with ischemic stroke (n=18) or TIA (n=6). All were treated initially with anticoagulation ± antiplatelet drugs. Eight of these patients had no or mild carotid stenosis on initial angiography and were treated with medical management alone. The remaining 16 patients had moderate or severe carotid stenosis on initial angiography. Of these, 10 underwent delayed revascularization (endarterectomy, n=8; angioplasty and stenting, n=2), 2 refused revascularization, and 4 were treated with medical therapy alone. One patient had multiple TIAs despite medical therapy and eventually underwent CEA; the remaining 23 patients had no TIAs. No patient suffered ischemic or hemorrhagic stroke while on anticoagulation, during the perioperative period or in long-term follow up; one patient died of an unrelated condition (mean follow-up = 16.4 months). Conclusion Our results suggest that initial anticoagulation of symptomatic ICT results in a low rate of recurrent ischemic events and that carotid revascularization, if indicated, can be safely performed in a delayed manner.

The Thrombolytic Effect of Diagnostic Ultrasound–Induced Microbubble Cavitation in Acute Carotid Thromboembolism

“…Acute carotid artery thromboses typically occurs in the setting of either an underlying carotid stenosis or as an embolus from a left ventricular cavity thrombus, and is associated with a high risk of downstream ischemic events (33). When detected by computed tomography, it is often treated as an emergency requiring angiography and endovascular intervention (9,10,33,34).…”

“…When detected by computed tomography, it is often treated as an emergency requiring angiography and endovascular intervention (9,10,33,34). In this study, we demonstrated that in treating acute CA thromboses that develop in the region of a stenosis, diagnostic ultrasound high MI impulses which induce SC can effectively recanalize the CA thrombus, and restore downstream flow in the major branches emanating from the common carotid artery.…”

Urgent carotid endarterectomy in carotid artery stenosis with a pedunculated thrombus: a case report

“…[2] The goal of surgery is to improve the existing perfusion by removing the thrombus or the source of emboli and to protect against further stroke. Furthermore, early surgery before a possible acute stroke may decrease the higher risk of intracranial bleeding and embolization due to treatment options as thrombolysis or endovascular intervention.…”

“…[1] It can be found both in the presence or absence of carotid artery stenosis. [2] An intraluminal thrombus may occur secondary to the extension of intraplaque hemorrhage and may produce significant morbidity and mortality, in case of proceeding to thrombotic occlusion or embolic events.…”

Endovascular Management of Extracranial Carotid Disease

“…Although no randomized trials exist, initial treatment with systemic anticoagulation appears to be efficacious (Pelz et al 1986;Vellimana et al 2013) (Fig. 8).…”