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Published on: September 25, 2016
The strategy for internal carotid stenosis with thrombus
1Department of Neurological Surgery; Wakayama Medical College; Wakayama, Japan - omasuo@wakayama-med.ac.jp.
Insights
Internal carotid artery (ICA) stenosis with thrombus presents risks like stroke. Percutaneous transluminal angioplasty (PTA) with stenting, using a protective system, offers a viable treatment alternative to carotid endarterectomy (CEA).
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Internal carotid artery (ICA) stenosis with thrombus poses a significant risk for cerebrovascular events.
- Traditional treatment options may carry risks of embolic complications.
- Novel endovascular techniques are being explored for managing complex carotid artery disease.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous transluminal angioplasty (PTA) and stenting with a protective system in patients with ICA stenosis and thrombus.
- To compare outcomes of endovascular treatment versus surgical intervention in this specific patient cohort.
Main Methods:
- Retrospective analysis of 3 cases with ICA stenosis and thrombus.
- All patients received initial anticoagulation and antiplatelet therapy.
- Treatment strategies included carotid endarterectomy (CEA) in one case and PTA with stenting using a protective technique in two cases.
Main Results:
- Carotid endarterectomy (CEA) in one patient resulted in minor cerebral embolic infarction during the waiting period.
- Percutaneous transluminal angioplasty (PTA) and stenting with a protective system in two patients showed no embolic complications.
- Postoperative angiography confirmed adequate lumen dilatation after PTA/stenting.
Conclusions:
- Percutaneous transluminal angioplasty (PTA) and stenting using a protective system appears to be a safe and effective alternative for treating internal carotid artery (ICA) stenosis with thrombus.
- This endovascular approach may reduce the risk of embolic complications compared to delayed surgical intervention in select cases.
Summary:
We report 3 cases of internal carotid artery (ICA) stenosis with thrombus. The initial symptom is transient ischemic attack (TIA) in 1 case, and cerebral infarction due to artery-to-artery embolism in 2 cases.We started anticoagulation and antiplatelet therapy after the angiography on admission in all cases. Carotid endarterectomy (CEA) was performed in 1 case after confirming the disappearance of the thrombus 1 month after the initial attack, although small cerebral embolic infarction happened during this period. In the other cases, percutaneous transluminal angioplasty (PTA) and stenting was performed using the protective technique about 2 weeks after the initial attack without embolic complication. Postoperative angiography showed sufficient dilatation. It seemed that PTA/stenting using the protection system was one of the alternatives for ICA stenosis with thrombus.
