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Intraluminal thrombus in the cerebral circulation. Implications for surgical management
1Department of Clinical Neurological Sciences, University of Western Ontario, University Hospital, London, Canada.
Stroke
|June 1, 1988
Summary
Intraluminal thrombi detected via angiography in 30 patients often indicate severe stenosis and increase operative risk. Medical management showed thrombus resolution in most cases, suggesting a potential for delayed surgery.
Area of Science:
- Vascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Cerebrovascular thrombi detected by angiography are rare but significant findings.
- Understanding the clinical presentation and management of these thrombi is crucial for patient outcomes.
Purpose of the Study:
- To investigate the characteristics, clinical presentations, and management outcomes of patients with angiographically detected thrombi.
- To assess the impact of thrombus presence on surgical intervention and outcomes.
Main Methods:
- Retrospective analysis of 30 patients with angiographically identified intraluminal thrombi.
- Review of clinical presentations, stenosis severity, management strategies (urgent surgery vs. medical management), and perioperative outcomes.
Main Results:
- Thrombi were predominantly in the carotid system (29/30) and associated with severe stenosis (23/30).
- Urgent surgery in 16 patients led to perioperative infarction in 4/11 with accessible thrombi.
- Medical management in 14 patients resulted in complete thrombus resolution in 7/8, with one stroke in delayed surgery.
Conclusions:
- Angiographically detected thrombi, often associated with stenosis, may increase operative risk.
- Medical management can lead to thrombus resolution, potentially allowing for safer delayed surgical intervention.