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Management Approaches to Intraluminal Thrombi in Acutely Symptomatic Carotid Stenosis

Davis MacLean1,2, Benjamin Beland2, Gordon A E Jewett2

  • 1Department of Clinical Neurosciences, Stroke Program, University of Calgary Cumming School of Medicine, Calgary, Canada.

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
|November 26, 2024
PubMed

Insights

A study on carotid stenosis with intraluminal thrombus found clinicians prefer anticoagulation and delayed revascularization. Further research is needed to understand the condition

Area of Science:

  • Neurology
  • Vascular Surgery
  • Clinical Practice

Background:

  • Intraluminal thrombus in acutely symptomatic carotid stenosis is a high-risk lesion for stroke recurrence.
  • Limited evidence exists on the natural history and optimal treatment for this condition.
  • Significant practice variations exist in medical management and revascularization timing.

Purpose of the Study:

  • To map variations in clinical practice for managing carotid stenosis with intraluminal thrombus.
  • To identify factors influencing clinician decision-making.
  • To gather expert opinions for future clinical trial design.

Main Methods:

  • Mixed-methods study combining quantitative surveys and qualitative interviews.
  • International perspectives gathered through a case-based survey in Neurology: Clinical Practice.
  • Expert interviews conducted using established qualitative research methodologies.

Main Results:

  • The presence of intraluminal thrombus significantly increased the likelihood of using anticoagulation (p < 0.001).
  • Key themes from interviews included therapeutic uncertainty regarding anticoagulation, decisions on reimaging, revascularization strategies, and trial design challenges.
  • A preference for anticoagulation and delayed revascularization after reimaging was observed.

Conclusions:

  • Clinicians show a preference for anticoagulation and delayed revascularization, aiming to assess clot resolution.
  • Substantial equipoise persists regarding the optimal management strategy.
  • Further research into the natural history of this condition is essential for informing future trial design and improving patient care.
Abstract

Keywords:
Carotid artery diseasecarotid endarterectomycerebrovascular diseasestrokevascular neurology

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