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The stroke syndrome of long intraluminal clot with incomplete vessel obstruction
Insights
A novel stroke syndrome involving long clot formation in arteries was identified in three patients. Surgical clot removal proved successful in the acute stage, offering a new treatment approach.
Area of Science:
- Neurology
- Vascular Surgery
Background:
- Stroke is a leading cause of disability and death worldwide.
- Understanding the diverse mechanisms of ischemic stroke is crucial for effective treatment.
- Intraluminal clot formation can lead to incomplete or complete vessel obstruction.
Observation:
- Three patients presented with a distinct stroke syndrome characterized by long intraluminal clot formation.
- Angiography revealed incomplete obstruction in the affected vessels.
- The involved arteries were the carotid arteries (2 cases) and the vertebral artery (1 case).
Findings:
- Common features included vessel tenderness (carotidynia or vertebral artery tenderness), vascular headache, and subintimal hemorrhage acting as a clot anchor.
- Recurrent clinical events were noted in these patients.
- Surgical embolectomy was successfully performed in all three cases during the acute phase.
Implications:
- This syndrome highlights a specific mechanism of arterial clot formation potentially preceding complete occlusion.
- Early surgical intervention for these specific clot formations can be effective.
- Recognition of this syndrome may improve diagnosis and treatment of certain stroke cases.
Abstract:
A stroke syndrome is described in 3 patients where long intraluminal clot formation with incomplete vessel obstruction was seen angiographically. The vessel involved in 2 cases were carotid arteries and in the third a vertebral artery. The intervening phase of long clot formation may be a feature of many cases of complete vessel occlusion. The common features of the syndrome were vessel tenderness (carotidynia in 2 cases, and vertebral artery tenderness in the third), vascular headache, the presence of subintimal haemorrhage as an anchor point for the clot, and the recurrence of clinical events. Surgical removal of these clots were successfully undertaken in each case at the acute stage.