| Article Access Statistics|
| Viewed||302 |
| Printed||10 |
| Emailed||0 |
| PDF Downloaded||13 |
| Comments ||[Add] |
Click on image for details.
|Year : 2021 | Volume
| Issue : 5 | Page : 1269-1270
Free-Floating Thrombus in the Carotid Artery Without Atherosclerosis Dissolved by Antithrombotic Therapy
Eri Shiozaki, Yoichi Morofuji, Ichiro Kawahara, Keisuke Tsutsumi
Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan
|Date of Submission||15-Jan-2021|
|Date of Decision||29-Mar-2021|
|Date of Acceptance||06-Jul-2021|
|Date of Web Publication||30-Oct-2021|
Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki - 856-8562
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shiozaki E, Morofuji Y, Kawahara I, Tsutsumi K. Free-Floating Thrombus in the Carotid Artery Without Atherosclerosis Dissolved by Antithrombotic Therapy. Neurol India 2021;69:1269-70
|How to cite this URL:|
Shiozaki E, Morofuji Y, Kawahara I, Tsutsumi K. Free-Floating Thrombus in the Carotid Artery Without Atherosclerosis Dissolved by Antithrombotic Therapy. Neurol India [serial online] 2021 [cited 2021 Dec 3];69:1269-70. Available from: https://www.neurologyindia.com/text.asp?2021/69/5/1269/329578
| » Clinical Images|| |
A 68-year-old man presented with sudden right upper limb weakness. Once the symptom improved, it reappeared on the same day. Magnetic resonance imaging showed acute small cerebral infarction in the left watershed area. The carotid ultrasonography demonstrated free-floating thrombus (FFT) in the proximal left internal carotid artery (ICA). The thrombus was about 3 cm long and had mobility. Computed tomography angiography (CTA) showed filling defect in the left ICA. There was no atherosclerosis in the ICA, and the biochemical investigation showed no hypercoagulable states. We started on antithrombotic therapy and planned for thromboendarterectomy (TEA). However, the ultrasonography on the 11th day demonstrated extreme diminish of the FFT, and only the residual root of the thrombus was detected. The FFT disappeared completely on the 17th day and did not have recurrence for 6 months [Figure 1].
|Figure 1: (a) Carotid ultrasonography demonstrates free-floating thrombus (FFT) attached to the left internal carotid artery (ICA). There was no plaque or stenosis in the ICA. (b) Computed tomography angiography (CTA) shows a long filling defect in the left ICA. (c and d): Carotid ultrasonography and CTA 3 weeks after the admission. The FFT has completely dissolved by anticoagulant and antiplatelet therapy|
Click here to view
There is no consensus on the treatment for FFT. Some have reported the favorable outcomes of acute TEA or carotid stenting for FFT,, but the morbidity of surgical or interventional treatment for FFT is higher than that for the usual atherosclerotic plaque. Anticoagulated therapy has been reported to be effective to dissolve FFT, although most FFT are related to atherosclerotic stenosis and require delayed surgical treatment., In the present case, FFT was attached to the ICA without any plaque. We suspect that the undetectable endothelium injury or subsequent inflammation process might have caused FFT, and we continued antiplatelet therapy after FFT dissolved.
In conclusion, FFT can be dissolved by medical management alone and not all FFT need surgical treatment in the acute phase.
Conception and Design: Shiozaki, Morofuji. Acquisition of data: Shiozaki. Drafting the article: Shiozaki, Morofuji. Critically revising the article: all authors.
We wish to thank Yuka Ogawa, Takehiro Ito, Kazuya Honda, Tomonori Ono, and Wataru Haraguchi for providing insight and expertise to assist this article.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| » References|| |
Jahromi BS, Tummala RP, Yamamoto J, Levy EI, Siddiqui AH, Hopkins LN. Early carotid stenting for symptomatic stenosis and intraluminal thrombus presenting with stroke. Neurology 2008;71:1831-3.
Lane TR, Shalhoub J, Perera R, Mehta A, Ellis MR, Sandison A, et al
. Diagnosis and surgical management of free-floating thrombus within the carotid artery. Vasc Endovascular Surg 2010;44:586-93.
Buchan A, Gates P, Pelz D, Barnett HJ. Intraluminal thrombus in the cerebral circulation. Implications for surgical management. Stroke 1988;19:681-7.
Vellimana AK, Kadkhodayan Y, Rich KM, Cross DT 3rd
, Moran CJ, Zazulia AR, et al
. Symptomatic patients with intraluminal carotid artery thrombus: Outcome with a strategy of initial anticoagulation. J Neurosurg 2013;118:34-41.