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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Floating carotid thrombus treated by intravenous heparin and endarterectomy

Fabrizio Sallustio1, Silvia Di Legge, Simone Marziali

  • 1Stroke Unit, Department of Neuroscience, University of Tor Vergata, Rome, Italy. fabriziosallustio@libero.it

Journal of Vascular Surgery
|October 12, 2010
PubMed

Insights

Atherosclerotic stroke poses a high risk of worsening and recurrence. This case highlights the challenges in managing ischemic stroke caused by internal carotid artery thromboembolism.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Cardiovascular Research

Background:

  • Ischemic stroke, particularly atherosclerotic subtypes, presents significant risks for acute worsening and recurrence.
  • High-risk factors include plaque rupture, thrombus formation, propagation, vessel occlusion, and distal embolism.
  • Management strategies like emergent endarterectomy or anticoagulation followed by delayed endarterectomy remain controversial.

Observation:

  • This report details a patient experiencing an ischemic stroke.
  • The stroke was attributed to thromboembolism originating from an ulcerated plaque with a floating thrombus.
  • The affected artery was the internal carotid artery (ICA).

Findings:

  • The patient's ischemic stroke was caused by thromboembolism from an internal carotid artery ulcerated plaque with a floating thrombus.
  • The case involves a discussion regarding the controversial application of heparin therapy.

Implications:

  • This case underscores the complexities in treating acute ischemic stroke secondary to internal carotid artery disease.
  • It prompts further discussion on the efficacy and risks of anticoagulation, such as heparin, in specific thromboembolic stroke scenarios.
  • Understanding these mechanisms is crucial for refining acute stroke management protocols and improving patient outcomes.

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