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Free-floating thrombus of the extracranial internal carotid artery
J Combe1, P Poinsard, J Besancenot
1Service de Chirurgie Vasculaire, C.H.U. Jean Minjoz, Besançon, France.
Insights
Free-floating carotid artery clots are not always surgical emergencies. Late diagnosis and heparin treatment showed significant clot lysis, suggesting a less urgent approach is possible.
Area of Science:
- Vascular Surgery
- Neurology
- Radiology
Background:
- Free-floating clots in the extracranial internal carotid artery are typically viewed as surgical emergencies.
- These clots can lead to significant neurological deficits, including stroke and transient ischemic attacks.
Purpose of the Study:
- To analyze the outcomes of treating free-floating carotid artery clots with heparin, particularly when diagnosed late.
- To re-evaluate the classification of free-floating thrombus syndrome as a surgical emergency.
Main Methods:
- Retrospective analysis of six patients with free-floating internal carotid artery clots diagnosed via arteriography.
- Treatment involved intravenous heparin for two to five weeks, with follow-up arteriograms.
- Assessment of neurological status and arteriographic findings before and after treatment.
Main Results:
- Four out of six patients experienced complete clot lysis with heparin treatment.
- One patient had partial lysis, and one showed thrombus extension.
- No new neurological complications occurred during heparin therapy.
- Five patients underwent secondary surgery for residual lesions or clots.
Conclusions:
- Late-discovered free-floating carotid artery thrombi may not require immediate surgery.
- Intravenous heparin can be an effective treatment, leading to significant clot lysis.
- The urgency of surgical intervention should be reconsidered based on late diagnosis and treatment response.
Abstract:
Free-floating clots of the extracranial internal carotid artery are generally considered as surgical emergencies. This retrospective study analyzes six free-floating clots diagnosed by arteriography. Three of these patients had a fixed stroke while the other three had an evolving stroke. Three patients had antecedent ocular or hemispheric transient ischemic attacks. The causes of free-floating clots in the internal carotid artery were atheromatous stenosis in two cases, ulcerated plaque in three cases, and carotid artery dissection in one. All six patients were seen late, approximately 15 hours after their neurologic accident. They were treated with intravenous heparin over a two to five week period. Repeat arteriograms demonstrated complete clot lysis in four instances, while partial lysis was seen in one case. Moderate extension of thrombus occurred in one case only. No further neurologic complications were noted during the treatment by heparin. As indicated by follow-up arteriographic findings, secondary surgery was performed for major carotid lesions and residual clots in five cases. The free-floating thrombus syndrome of the carotid artery should not be considered as a surgical emergency when discovered late in the wake of an acute neurologic accident.