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Acute carotid artery thrombosis: description of 12 surgically treated cases
Jean-Philippe Berthet1, Charles-Henri Marty-Ané, Eric Picard
1Department of Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France. jp-berthet@chu-montpellier.fr
Insights
Urgent surgery for acute carotid artery thrombosis offers high recovery rates. Prompt revascularization within 6 hours is crucial for successful outcomes in selected patients.
Area of Science:
- Vascular Surgery
- Neurology
Background:
- Acute internal carotid artery thrombosis carries high morbidity and mortality with medical treatment.
- Patients often present with severe neurologic deficits.
Purpose of the Study:
- To evaluate the efficacy of urgent surgical intervention for primary acute carotid artery thrombosis.
- To determine outcomes based on timing of revascularization.
Main Methods:
- Retrospective review of 12 patients undergoing urgent carotid thromboendarterectomy.
- Procedures included shunt placement, prosthetic patch closure, and intraoperative angiography.
- All patients had severe neurologic deficits and symptom onset < 6 hours prior to admission.
Main Results:
- Full neurologic recovery in 9 out of 12 patients.
- Partial recovery in 2 patients; 1 death occurred in a patient with delayed revascularization (>6 hours).
- No deaths directly attributed to the surgical procedure.
Conclusions:
- Urgent surgical intervention is effective for selected patients with acute carotid artery thrombosis.
- Revascularization within 6 hours of symptom onset is critical for favorable outcomes.
- Surgical treatment should be considered in patients without major consciousness disturbances or hemorrhagic infarction.
Abstract:
The morbidity and mortality of stroke secondary to acute internal carotid artery thrombosis range from 40 to 69% and from 15 to 55%, respectively, after purely medical treatment. This report describes a series of 12 patients who underwent urgent surgical treatment for primary acute carotid artery thrombosis between January 1999 and December 2002. Upon admission, all patients had severe neurologic deficits contralateral to carotid artery thrombosis. One patient experienced ongoing changes in the level of consciousness. The interval between the onset of symptoms and admission was less than 6 hr in all cases. Initial work-up in all patients included a brain computed tomographic scan with contrast injection and carotid duplex scan. The operative procedure consisted of carotid thomboemdarterectomy after shunt placement with prosthetic patch closure. Intraoperative angiography was performed in all cases. Following treatment, we observed deterioration of neurologic status leading to death in one case; improvement with partial regression of initial neurologic deficit in two cases, including one patient who died from causes unrelated to carotid artery disease; and full neurologic recovery in nine cases. The delay to revascularization was longer than 6 hr in both patients who died. These data support surgical intervention for carotid artery thrombosis in selected patients without major disturbances of consciousness or hemorrhagic infarction, provided that the delay to revascularization is less than 6 hr.
