Surgical management of intraluminal carotid thrombi

The most suitable treatment for intraluminal carotid thrombi remains still a much debated question. Some authors have reported a lower morbidity in patients treated with anticoagulant or antiplatelet therapy; on the other side, urgent or delayed surgery is burdened with a high risk of perioperative stroke. Over 11 years (october 1981-november 1992) 602 surgical revascularizations on epi-aortic vessels have been performed at Vascular Surgery Unit of Udine Regional Hospital. Only 2 cases of intraluminal carotid thrombi were observed: both fulfilled the angiographic requirements for endovasal filling defect, surrounded by contrast medium, adherent to posterior wall and extending to distal internal carotid artery. First patient suffered a TIA 20 days before surgery, the second one a previous major stroke contralateral to the thrombus. The former was given preoperatively a medical anticoagulant treatment (warfarin). At operation we discovered a nearly complete resolution of the thrombus: only its adherent base was still present. Therefore we performed a routine endarterectomy and a PTFE patch angioplasty. The latter case reported had no preliminary medical treatment; a thrombus extending from carotid bulbus to external and internal carotid was detected and then removed without any distal embolization. Arteriotomy was closed by Dacron Velour patch angioplasty. No perioperative stroke occurred in both cases: our second patient showed a partial resolution of his motility deficit. According to our limited experience, delayed surgical treatment of intraluminal carotid thrombi seems not to be affected with higher risk of perioperative stroke than prophylactic carotid endarterectomy.(ABSTRACT TRUNCATED AT 250 WORDS)