Free-floating thrombus in the internal carotid artery treated by anticoagulation and delayed carotid endarterectomy

Česká verze

Authors: M. Leško ml. ¹; I. Guňka ¹; Miroslav Lojík ² ; D. Krajíčková ³
Authors place of work: Chirurgická klinika FN Hradec Králové, přednosta: MUDr. M. Leško, Ph. D. ¹; Radiologická klinika FN Hradec Králové, přednosta: prof. MUDr. A. Krajina, CSc. ²; Neurologická klinika FN Hradec Králové, přednosta: doc. MUDr. M. Vališ, Ph. D. ³
Published in the journal: Rozhl. Chir., 2016, roč. 95, č. 8, s. 325-328.
Category: Kazuistika

Summary

Free-floating thrombus in the internal carotid artery is a rare clinical finding. Only case reports and small cohorts of patients are described in the literature. The authors present a case report of a patient with ischemic stroke due to arterio-arterial embolisation from ulcerated internal carotid artery stenosis with a free-floating thrombus. Initially, the patient was treated with anticoagulants, resulting in total dissolution of the free-floating thrombus based on ultrasound documentation, without any further symptomatic embolisation. Endarterectomy was performed in the second step for the critical stenosis of the internal carotid artery. After this combined treatment, the patient showed no neurological deficit. Currently, the opinion on optimal therapy of the free-floating thrombus in the internal carotid artery still remains unclear.

Key words:
free-floating thrombus – anticoagulation − internal carotid artery

Zdroje

1. Bhatti AF, Leon LR Jr, Labropoulos N, et al. Free-floating thrombus of the carotid artery: Literature review and case reports. Journal of Vascular Surgery 2007;45:199−205.

2. Chiari H. Über das Verhalten des Teilungswinkels der Carotis communis bei der Endarteritis chronic deformans. Verh Dtsch Ges Pathol 1905;9:326−30.

3. Gunning AJ. Mural thrombosis of the internal carotid artery and subsequent embolism. Q J Med 1964; 33:155−95.

4. Fabrizio S. Floating carotid thrombus treated by intravenous heparin and endarterectomy. Journal of Vascular Surgery 2011;53:489−91.

5. Stephen H. Extensive mobile trombus of the internal carotid artery: Acese report, treatment options, and review of the literature. The American Surg 2005;71:853−6.

6. Rutherford‘s Vascular Surgery. 7th edition, Vol. 2, Elsevier 2010:1424−40.

7. Rothwell PM. Carotid endarterectomy trialists collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004;363:915−24.

8. Bhatia R, Hill MD, Shobha N, et al. Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke 2010;41:2254−8.

9. Christou I, Felberg RA, Demchuk AM, et al. Intravenous tissue plasminogen activator and flow improvement in acute ischemic stroke patients with internal carotid artery occlusion. J Neuroimaging 2002;12:119−23.

10. Chan JL. Reccurent stroke onset precipitated during carotid ultrasound examination in a case of severe internal carotid artery stenosis with soft, moving plaques. Recent advances in neurosonology: proceedings of the Fourth Meeting of Neurosonology Research Group of the World Federation of Neurology, Hiroshima 1991. Amsterodam, Elsevier 1992;441−3.