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Resolution of Occlusive Carotid Artery Thrombus Treated with Anticoagulation as Demonstrated on Duplex
Laura Stein1, John W Liang2,3, Jesse Weinberger1
1Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY.
Insights
Nonatherosclerotic carotid artery thrombus can be effectively treated with anticoagulation. Serial Doppler ultrasonography can monitor thrombus resolution, avoiding invasive procedures for stroke patients.
Area of Science:
- Vascular Neurology
- Diagnostic Imaging
Background:
- Cerebral ischemic events often stem from atherosclerotic plaque rupture in the carotid artery.
- Nonatherosclerotic carotid artery thrombus is an occasional cause of stroke, necessitating accurate diagnosis to guide treatment.
- Distinguishing thrombus from atherosclerotic plaque is crucial for appropriate patient management.
Observation:
- A review of three patients with nonatherosclerotic carotid thrombi treated with anticoagulation was conducted.
- Serial Doppler ultrasonography was employed to monitor thrombus resolution.
- B-mode duplex ultrasonography proved effective in visualizing thrombus changes.
Findings:
- Systemic anticoagulation successfully resolved occlusive carotid thrombus in all three patients.
- Doppler ultrasonography demonstrated the resolution of thrombus over time.
- Ultrasonographic characteristics, including morphology and resolution patterns, aid in differentiating thrombus from plaque.
Implications:
- Accurate identification of nonatherosclerotic thrombus can prevent unnecessary interventional procedures.
- Systemic anticoagulation offers a safe and effective treatment for carotid artery thrombus.
- This approach mitigates risks of future embolization and carotid artery occlusion in stroke patients.
Background And Purpose:
While the majority of cerebral ischemic events due to carotid occlusive disease result from atherosclerotic plaque rupture, intraluminal carotid artery thrombus occasionally occurs in patients without preexisting carotid atherosclerosis. Identification of nonatherosclerotic thrombus as the cause of the carotid occlusive disease can obviate the need for an interventional procedure, and resolution of thrombus can be monitored with B-mode duplex ultrasonography.
Methods:
We reviewed 3 patients treated on The Mount Sinai Hospital Stroke Unit with anticoagulation for nonatherosclerotic carotid thrombi and followed with serial Doppler ultrasonogrpahy for resolution of thrombus.
Results:
Occlusive carotid thrombus was successfully treated in all 3 patients with systemic anticoagulation. B-mode duplex ultrasonography allowed for demonstration of resolving thrombus.
Conclusion:
Differentiation between a stenotic plaque and occlusive thrombus can be achieved by ultrasonographic analysis of thrombus morphology, attachment site potential, and characteristics of a resolving thrombus. Systemic anticoagulation can safely and effectively eliminate the risk for future embolization and complete occlusion of the carotid artery in patients who present with transient ischemic events or completed infarcts of small size.
