|
1
|
Jayyusi F, AlBarakat MM, Al-Rousan HH, Alawajneh MM, Alkasabrah AR, Abujaber M, Aldabbas ME, Abuelsamen M, Alshgerat Y, Sayuri Y, Alhertani N, BaniAmer M, Shari I, Brašić JR. The Efficacy of Medical Interventions for Free-Floating Thrombus in Cerebrovascular Events: A Systematic Review. Brain Sci 2024; 14:801. [PMID: 39199493 PMCID: PMC11352359 DOI: 10.3390/brainsci14080801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/03/2024] [Accepted: 08/07/2024] [Indexed: 09/01/2024] Open
Abstract
Although free-floating thrombus (FFT) poses a significant risk of stroke or transient ischemic attack (TIA), optimal management strategies are uncertain. To determine the state-of-the-art of medical interventions for FFT, we conducted a systematic review of the efficacy of various medical interventions and factors influencing FFT resolution and recurrence. A comprehensive search of Embase, PubMed, and ScienceDirect identified 61 studies encompassing 179 patients with FFT-related stroke or TIA treated with anticoagulants, antiplatelets, or their combinations. Primary outcomes assessed were stroke recurrence and thrombus resolution. Statistical analyses (Fisher's exact test, chi-square test, Mann-Whitney test, and Kruskal-Wallis test) utilized significance set at p < 0.05. Over a median follow-up of 7 months, thrombus resolution occurred in 65% of patients, while 11.2% experienced recurrence, primarily as TIAs. Cardioembolism was significantly less common in resolved cases (p = 0.025). Combination therapy (antiplatelets, anticoagulants, and statins) significantly enhanced clot resolution (OR 11.4; 95% CI 1.436-91.91; p = 0.021) compared to monotherapies. Ulcerated plaque was a significant predictor of recurrence (OR 8.2; 95% CI 1.02-66.07; p = 0.048). These findings underscore the superiority of combination therapy in FFT management and highlight the need for targeted interventions in patients with ulcerated plaques to mitigate recurrence risk.
Collapse
Affiliation(s)
- Fairoz Jayyusi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Majd M. AlBarakat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Habib H. Al-Rousan
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Mohmmad M. Alawajneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Abdel Rahman Alkasabrah
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Mo’tasem Abujaber
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Mohammed E. Aldabbas
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Mustafa Abuelsamen
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Yahya Alshgerat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Yahia Sayuri
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Nazeeh Alhertani
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Mohammad BaniAmer
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Issa Shari
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - James Robert Brašić
- Department of Psychiatry, New York City Health and Hospitals/Bellevue, New York, NY 10016, USA
- Department of Psychiatry, New York University Grossman School of Medicine, New York University Langone Health, New York, NY 10016, USA
- Section of High-Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| |
Collapse
|
|
2
|
Onalan A, Gurkas E, Kursad Akpinar C, Aykac O, Uysal Kocabas Z, Dogan H, Temel M, Ozcan Ozdemir A. Safety and effectiveness of anticoagulation in the management of acute stroke and transient ischemic attack due to intracranial and extracranial non-occlusive thrombus. J Clin Neurosci 2024; 124:47-53. [PMID: 38643651 DOI: 10.1016/j.jocn.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION The awareness of nonocclusive thrombus has increased with the increasing frequency of imaging methods used for acute ischemic stroke; however, the best treatment for nonocclusive thrombi is still unknown. In this study, we examined how anticoagulants affect supra-aortic artery nonocclusive thrombus and clinical outcomes. MATERIALS AND METHODS This study included 52 patients with transient ischemic attack or stroke who were diagnosed with nonocclusive thrombi on computed tomography angiography at admission. Patients were treated with anticoagulant treatment and grouped according to treatment modality (either unfractionated heparin or low molecular weight heparin) and treatment duration. Primary safety outcome was major bleeding defined as immediate and clnically significant hemorrhage. Anticoagulant treatment was continued until the thrombus was resolved as determined by consecutive weekly computed tomography angiography controls. After thrombus resolution, treatment was directed according to the underlying etiology. Antiaggregation treatment was the preferred treatment after thrombus resolution for patients with no observed etiology. RESULTS The affected internal carotid arteries were most frequently located in the cervical segment (48 %). Complete resolution was achieved within 2 weeks in 50 patients (96 %). The involved vasculature included the following: the extracranial carotid artery segments (n = 26, 50 %), intracranial ICA segments (n = 10, 19 %), basilar artery segments (n = 8, 15 %) and MCA segments (n = 7, 13 %). The most common underlying pathologies were atherosclerosis (n = 17), atrial fibrillation (n = 17), undetermined embolic stroke (n = 8), dissection (n = 7), and malignancy (n = 2). No symptomatic intra- or extracranial bleeding complications due to anticoagulant use were observed in any patient during the study period. A good functional outcome (modified Rankin scale score 0-2) was achieved in 49 patients (94 %) at 3 months. There was no significant difference between treatment type and duration in terms of reinfarction (p = 0.97 and p = 0.78, respectively). CONCLUSION Anticoagulant treatment is safe and effective in symptomatic patients with intracranial or extracranial artery nonocclusive thrombus, regardless of the anticoagulant type, thrombus location and size.
Collapse
Affiliation(s)
- Aysenur Onalan
- University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey Department of Neurology, Stroke Center, Turkey.
| | - Erdem Gurkas
- University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey Department of Neurology, Stroke Center, Turkey
| | | | - Ozlem Aykac
- Eskisehir Osmangazi University, Department of Neurology, Stroke Center, Eskisehir, Turkey
| | - Zehra Uysal Kocabas
- Eskisehir Osmangazi University, Department of Neurology, Stroke Center, Eskisehir, Turkey
| | - Hasan Dogan
- Samsun University, Department of Neurology, Stroke Center, Samsun, Turkey
| | - Musa Temel
- Sanliurfa Mehmet Akif Inan Research Hospital, Department of Neurology, Sanliurfa, Turkey
| | - Atilla Ozcan Ozdemir
- Eskisehir Osmangazi University, Department of Neurology, Stroke Center, Eskisehir, Turkey
| |
Collapse
|
|
3
|
Efficacy and safety of intensified antithrombotic therapy followed by stenting in treatment of highly severe stenosis accompanied by thrombosis in carotid atherosclerosis. Clin Neurol Neurosurg 2022; 218:107274. [DOI: 10.1016/j.clineuro.2022.107274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/25/2022] [Accepted: 04/27/2022] [Indexed: 11/20/2022]
|
|
4
|
Alhashim A, Hadhiah K, Itani SA, Alshurem M, Alabdali M, Aljaafari D, AlQarni M. Management of Free-Floating Thrombus in the Vertebral Artery in a Middle-Aged Smoker with Secondary Polycythemia Vera. Int Med Case Rep J 2021; 14:663-668. [PMID: 34588824 PMCID: PMC8473712 DOI: 10.2147/imcrj.s325133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/03/2021] [Indexed: 11/23/2022] Open
Abstract
Free-floating thrombus (FFT) of the cervicocranial arteries is a rare neurovascular condition. Up to now, there is no standardized definition for FFT. Therefore, FFT is occasionally mistaken for intraluminal thrombus (ILT) or smooth mural thrombus. The most precise and ideal definition of FFT would be a long-extended intraarterial thrombus that is attached to the arterial wall with its one end, while its other end is surrounded by blood flow and moves freely with the cardiac cycle. FFT usually manifests as an ischemic stroke, thus it is considered as an emergency case. Herein, we report a rare case of symptomatic FFT in the left vertebral artery extending from V0 to V2 segments in a middle-aged smoker, who presented with multiple embolic strokes in different territories of posterior circulation and was successfully treated medically. This case sheds light on the challenges of the clinical approach of FFT in the vertebral artery and it is an attempt to draw attention to the necessity of conducting a large-scale study to find out the ideal approach to manage such conditions.
Collapse
Affiliation(s)
- Ali Alhashim
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Kawther Hadhiah
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Sarah A Itani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Mohammed Alshurem
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Majed Alabdali
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Danah Aljaafari
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Mustafa AlQarni
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| |
Collapse
|
|
5
|
Yang P, Li Y, Huang Y, Lu C, Liang W, Hu J. A giant floating thrombus in the ascending aorta: a case report. BMC Surg 2020; 20:321. [PMID: 33297988 PMCID: PMC7724786 DOI: 10.1186/s12893-020-00983-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023] Open
Abstract
Background A floating thrombus in an ascending aorta with normal morphology is very rare, but when it does occur, it may induce a systemic embolism or fatal stroke. The pathophysiological mechanisms of aortic mural thrombi remain unclear, and there is no consensus regarding therapeutic recommendations. Case presentation We report a 49-year-old male who presented with chest discomfort for 5 days and was admitted to our emergency unit. A contrast-enhanced computed tomography angiography (CTA) surprisingly demonstrated a large filling defect suggestive of a thrombus in his otherwise healthy distal ascending aorta. Surgical resection of the mass and attachment site was performed. Histological examination confirmed that the mass was a thrombus, but the cause of the thrombus formation was unknown. Conclusions floating aortic thrombi are rare, and they are prone to break off, thus carrying a potential risk for embolic events with catastrophic consequences. Surgical resection, both of the aortic thrombus and attachment site, as well as postoperative anticoagulant administration, are standard treatments.
Collapse
Affiliation(s)
- Peng Yang
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Ya Li
- West China Clinical Medicine School, Si Chuan University, No. 17 Section 3, South Renmin Road, Wuhou District, Chengdu, 610041, China
| | - Yao Huang
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Chen Lu
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Weitao Liang
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China.
| |
Collapse
|
|
6
|
Carotid Thrombosis in a Crack Cocaine Smoker Woman. Case Rep Vasc Med 2020; 2020:4894825. [PMID: 33083091 PMCID: PMC7557910 DOI: 10.1155/2020/4894825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 08/19/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction We report a case of stroke in a crack smoker with occlusion of the middle cerebral artery and a large thrombus in the carotid artery. Case Presentation. A 34-year-old female presented with left upper arm weakness, associated with paresthesia with onset of symptoms more than 24 hours before. Angio-RM sequences showed an area of ischemia, with occlusion of the M2 segment of the middle cerebral artery. Carotid ultrasound showed a soft plaque with distal end floating. Anticoagulant treatment was started, and seriated ultrasound evaluations showed its gradual dissolution. Conclusions In atherothromboembolic stroke from carotid thrombosis, repeated ultrasound studies may be useful for either diagnosis and monitoring the efficacy of anticoagulant therapy.
Collapse
|
|
7
|
Al-Jehani H, Alhamid MA, Alkhalaf Y, Alabbas F. A Case of Coincidental Free Floating Thrombus in the Vertebral Artery in a Patient Presenting with an Anterior Circulation Stroke and Literature Review. Neurointervention 2020; 15:144-153. [PMID: 32777873 PMCID: PMC7608498 DOI: 10.5469/neuroint.2020.00087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/21/2020] [Indexed: 11/24/2022] Open
Abstract
Free-floating thrombus (FFT) is a rare condition with unknown etiology as described by many case reports presented in previous literature. The patients usually present symptomatically while the other few patients remain asymptomatic and are usually discovered incidentally on computed tomography angiography (CTA). Most of the cases reported in the literature are of FFT in the internal carotid artery. We present a 59-year-old female as a case of FFT in the vertebral artery which was coincidently discovered on CTA in a patient initially presenting with an anterior circulation stroke. This case highlights the importance of early contrast-based vascular imaging in patients presenting with large vessel strokes that are cardioembolic in nature and the unique utilization of a direct aspiration first pass technique (ADAPT) for revascularization. Included herein an extensive review of the literature about the decision making in patients with FFT and a devised proposed practical approach to this entity.
Collapse
Affiliation(s)
- Hosam Al-Jehani
- Department of Neurosurgery, Interventional Radiology, King Fahad Hospital of The University, Imam Abdulrahman Bin Faisal, Dammam, Saudi Arabia.,Department of Neurology and Neursurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - May Adel Alhamid
- Department of Neurology, Interventional Radiology, King Fahad Hospital of The University, Imam Abdulrahman Bin Faisal, Dammam, Saudi Arabia
| | - Yousef Alkhalaf
- Department of Medicine, Royal Commision Hospital, Jubail, Saudi Arabia
| | - Faisal Alabbas
- Department of Neurosurgery, Interventional Radiology, King Fahad Hospital of The University, Imam Abdulrahman Bin Faisal, Dammam, Saudi Arabia
| |
Collapse
|
|
8
|
Imahori T, Tanaka K, Arai A, Kohmura E. Surgical Thromboendarterectomy for Free-Floating Thrombus Associated with Cervical Carotid Artery Dissection: A Case Report. Ann Vasc Surg 2020; 68:572.e9-572.e14. [PMID: 32439523 DOI: 10.1016/j.avsg.2020.04.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Free-floating thrombus (FFT) of the cervical carotid artery is a rare but critical condition leading to stroke. The most common underlying pathology is atherosclerotic plaque; nonatherosclerotic pathologies are much rarer. Here we report a case of FFT associated with cervical carotid artery dissection that was successfully treated by surgical thromboendarterectomy. METHODS A 51-year-old man presented with headache, pain in the left neck, and amaurosis fugax. Magnetic resonance angiography revealed mild stenosis in the bifurcation of the left carotid artery. The stenotic lesion was considered as a possible dissection because of the normal appearance of the vessel 2 years ago and its clinical presentation. Oral aspirin was initiated with the diagnosis of transient ischemic attack. Two weeks later, ultrasound was planned for further examination, which demonstrated a massive FFT with intramural hematoma in the lesion. Because FFT was present despite taking aspirin, surgical thromboendarterectomy was performed to prevent further ischemic events. RESULTS Intraoperative findings revealed that FFT was the thrombus protruding from the intramural hematoma caused by arterial dissection. After the whole dissected layer was removed, the residual lumen was reinforced by multiple tacking sutures to prevent recurrence of dissection. No further ischemic events and recurrence occurred during the 1-year of follow-up after the surgery. CONCLUSIONS When managing patients with carotid artery dissection, the formation of FFT should be considered as a possible critical feature. Surgical thromboendarterectomy with intimal tacking sutures might be an option for the treatment, ensuring immediate, preventive effects against the risk of cerebral embolism.
Collapse
Affiliation(s)
| | | | - Atsushi Arai
- Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| |
Collapse
|
|
9
|
Mancuso E, Winterbottom AP, Boyle JR, Hildebrand DR. Management and clinical outcome of concomitant pulmonary embolism and paradoxical saddle aortic arch embolism. BMJ Case Rep 2019; 12:e230024. [PMID: 31466979 PMCID: PMC6720682 DOI: 10.1136/bcr-2019-230024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2019] [Indexed: 11/03/2022] Open
Abstract
A 65-year-old man presented in a peri-arrest situation after collapse, he was found hypoxic with ischaemic arms. CT imaging showed massive bilateral pulmonary embolisms (PEs) and an aortic arch embolus extending from brachiocephalic trunk to left subclavian artery. Following intravenous thrombolysis, repeat imaging revealed that the aortic embolus had migrated distally into both axillary arteries and had occluded the right carotid from origin to skull base. Bilateral upper limb embolectomies were carried out from the brachial arteries together with forearm fasciotomies. Left hemianopia related to a right middle cerebral artery territory infarct was managed conservatively; forearm fasciotomy wounds were primarily closed and the patient was discharged on lifelong anticoagulation. A transoesophageal echocardiogram revealed a patent foramen ovale. This case demonstrates a very unusual presentation of concomitant PE and paradoxical saddle aortic arch embolism. A multidisciplinary approach has resulted in an excellent clinical outcome for this complex patient.
Collapse
MESH Headings
- Aged
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/pathology
- Computed Tomography Angiography/methods
- Echocardiography, Transesophageal/methods
- Embolism, Paradoxical/complications
- Embolism, Paradoxical/diagnostic imaging
- Embolism, Paradoxical/therapy
- Foramen Ovale, Patent/complications
- Foramen Ovale, Patent/diagnostic imaging
- Humans
- Infarction, Middle Cerebral Artery/complications
- Infarction, Middle Cerebral Artery/diagnostic imaging
- Male
- Patient Care Team/standards
- Pulmonary Embolism/complications
- Pulmonary Embolism/diagnostic imaging
- Pulmonary Embolism/therapy
- Shock, Cardiogenic/diagnosis
- Shock, Cardiogenic/etiology
- Thrombolytic Therapy/methods
- Treatment Outcome
Collapse
Affiliation(s)
| | | | - Jonathan R Boyle
- Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Diane R Hildebrand
- Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
|
10
|
Labeyrie MA, Ducroux C, Civelli V, Reiner P, Cognat E, Aymard A, Bisdorff A, Saint-Maurice JP, Houdart E. Endovascular management of extracranial occlusions at the hyperacute phase of stroke with tandem occlusions. J Neuroradiol 2017; 45:196-201. [PMID: 29132938 DOI: 10.1016/j.neurad.2017.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The management of cervical artery occlusions in hyperacute stroke with tandem cervical/intracranial occlusions has not yet become standardized, especially when the circle of Willis is effective. METHODS We retrospectively analyzed the safety and accuracy of current approaches to manage the cervical occlusion in consecutive patients with tandem occlusions addressed for intracranial mechanical thrombectomy (MT) in our department from January 2012 to May 2017. The different approaches that could be performed in a same patient during the same procedure or hospitalization were analyzed separately. RESULTS We reported 64 approaches to manage the cervical occlusion in 49 patients with tandem occlusion (14% of MT): medical treatment alone in 16/64 (25%), stenting/angioplasty in 16/64 (25%), occlusion with coils in 12/64 (19%), angioplasty alone in 9/64 (14%), stent-retriever in 8/64 (12%), and/or thromboaspiration in 3/64 (5%). Early ipsilateral embolic recurrence occurred after 9/64 (14%) of them. It was strongly associated with the presence of a cervical intraluminal thrombus (P=0.001) and was then lower after occlusion with coils and stent-retriever compared to medical treatment alone and thromboaspiration (P=0.002). Occlusion with coils had a lower rate of radiological intracranial hemorrhage at 48-hour compared to other approaches (P=0.009). The 3-month rates of favorable outcome (P=0.806) and mortality (P=0.878) were similar. One delayed stroke was imputable to an occlusion with coils, for a median (Q1-Q3) follow-up of 10 (3-20) months. CONCLUSIONS Cervical occlusion with coils and thrombectomy with stent-retrievers may be relevant to prevent early embolic recurrence in cervical occlusions with intraluminal thrombus. Stent-retrievers should be further assessed as a first-line approach, since delayed stroke may occur following occlusion with coils. Medical treatment alone may be sufficient when no cervical intraluminal thrombus is present, the Willis polygon is effective, and the cervical occlusion can be crossed easily to perform the intracranial thrombectomy.
Collapse
Affiliation(s)
- M-A Labeyrie
- Department of Interventional Neuroradiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; EA 7334 REMES (MAL, EH), université de Paris 7, 75013 Paris, France.
| | - C Ducroux
- Department of Interventional Neuroradiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - V Civelli
- Department of Neurology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - P Reiner
- Department of Neurology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - E Cognat
- Department of Interventional Neuroradiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; EA 7334 REMES (MAL, EH), université de Paris 7, 75013 Paris, France
| | - A Aymard
- Department of Interventional Neuroradiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; EA 7334 REMES (MAL, EH), université de Paris 7, 75013 Paris, France
| | - A Bisdorff
- Department of Interventional Neuroradiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; EA 7334 REMES (MAL, EH), université de Paris 7, 75013 Paris, France
| | - J-P Saint-Maurice
- Department of Interventional Neuroradiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; EA 7334 REMES (MAL, EH), université de Paris 7, 75013 Paris, France
| | - E Houdart
- Department of Interventional Neuroradiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; EA 7334 REMES (MAL, EH), université de Paris 7, 75013 Paris, France
| |
Collapse
|
|
11
|
Free Floating Thrombus in Carotid Artery in a Patient with Recurrent Strokes. Case Rep Med 2017; 2017:4932567. [PMID: 28163720 PMCID: PMC5259659 DOI: 10.1155/2017/4932567] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 12/18/2016] [Indexed: 11/18/2022] Open
Abstract
We present a case of 72-year-old male with reported past medical history of recurrent transient ischemic attacks (TIAs) presenting with myriad of neurological symptoms. Patient was transferred from outlying hospital with complaints of right sided facial droop and dysarthria. Computed tomography angiography (CTA) showed high grade proximal left internal carotid artery (ICA) stenosis along with interesting finding of a free floating thrombus (FFT) in the left ICA. After discussion with the neurosurgical team, our case was treated conservatively with combination of antiplatelet therapy with Aspirin and anticoagulation with Warfarin without recurrence of TIAs or strokes on six-month follow-up.
Collapse
|