Atormac
briv
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 14068  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (662 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
  Clinical Images
   References
   Article Figures

 Article Access Statistics
    Viewed284    
    Printed10    
    Emailed0    
    PDF Downloaded13    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1269-1270

Free-Floating Thrombus in the Carotid Artery Without Atherosclerosis Dissolved by Antithrombotic Therapy


Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan

Date of Submission15-Jan-2021
Date of Decision29-Mar-2021
Date of Acceptance06-Jul-2021
Date of Web Publication30-Oct-2021

Correspondence Address:
Yoichi Morofuji
Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki - 856-8562
Japan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.329578

Rights and Permissions



How to cite this article:
Shiozaki E, Morofuji Y, Kawahara I, Tsutsumi K. Free-Floating Thrombus in the Carotid Artery Without Atherosclerosis Dissolved by Antithrombotic Therapy. Neurol India 2021;69:1269-70

How to cite this URL:
Shiozaki E, Morofuji Y, Kawahara I, Tsutsumi K. Free-Floating Thrombus in the Carotid Artery Without Atherosclerosis Dissolved by Antithrombotic Therapy. Neurol India [serial online] 2021 [cited 2021 Dec 2];69:1269-70. Available from: https://www.neurologyindia.com/text.asp?2021/69/5/1269/329578





  Clinical Images Top


A 68-year-old man presented with sudden right upper limb weakness. Once the symptom improved, it reappeared on the same day. Magnetic resonance imaging showed acute small cerebral infarction in the left watershed area. The carotid ultrasonography demonstrated free-floating thrombus (FFT) in the proximal left internal carotid artery (ICA). The thrombus was about 3 cm long and had mobility. Computed tomography angiography (CTA) showed filling defect in the left ICA. There was no atherosclerosis in the ICA, and the biochemical investigation showed no hypercoagulable states. We started on antithrombotic therapy and planned for thromboendarterectomy (TEA). However, the ultrasonography on the 11th day demonstrated extreme diminish of the FFT, and only the residual root of the thrombus was detected. The FFT disappeared completely on the 17th day and did not have recurrence for 6 months [Figure 1].
Figure 1: (a) Carotid ultrasonography demonstrates free-floating thrombus (FFT) attached to the left internal carotid artery (ICA). There was no plaque or stenosis in the ICA. (b) Computed tomography angiography (CTA) shows a long filling defect in the left ICA. (c and d): Carotid ultrasonography and CTA 3 weeks after the admission. The FFT has completely dissolved by anticoagulant and antiplatelet therapy

Click here to view


There is no consensus on the treatment for FFT. Some have reported the favorable outcomes of acute TEA or carotid stenting for FFT,[1],[2] but the morbidity of surgical or interventional treatment for FFT is higher than that for the usual atherosclerotic plaque. Anticoagulated therapy has been reported to be effective to dissolve FFT, although most FFT are related to atherosclerotic stenosis and require delayed surgical treatment.[3],[4] In the present case, FFT was attached to the ICA without any plaque. We suspect that the undetectable endothelium injury or subsequent inflammation process might have caused FFT, and we continued antiplatelet therapy after FFT dissolved.

In conclusion, FFT can be dissolved by medical management alone and not all FFT need surgical treatment in the acute phase.

Authors' contributions

Conception and Design: Shiozaki, Morofuji. Acquisition of data: Shiozaki. Drafting the article: Shiozaki, Morofuji. Critically revising the article: all authors.

Acknowledgments

We wish to thank Yuka Ogawa, Takehiro Ito, Kazuya Honda, Tomonori Ono, and Wataru Haraguchi for providing insight and expertise to assist this article.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jahromi BS, Tummala RP, Yamamoto J, Levy EI, Siddiqui AH, Hopkins LN. Early carotid stenting for symptomatic stenosis and intraluminal thrombus presenting with stroke. Neurology 2008;71:1831-3.  Back to cited text no. 1
    
2.
Lane TR, Shalhoub J, Perera R, Mehta A, Ellis MR, Sandison A, et al. Diagnosis and surgical management of free-floating thrombus within the carotid artery. Vasc Endovascular Surg 2010;44:586-93.  Back to cited text no. 2
    
3.
Buchan A, Gates P, Pelz D, Barnett HJ. Intraluminal thrombus in the cerebral circulation. Implications for surgical management. Stroke 1988;19:681-7.  Back to cited text no. 3
    
4.
Vellimana AK, Kadkhodayan Y, Rich KM, Cross DT 3rd, Moran CJ, Zazulia AR, et al. Symptomatic patients with intraluminal carotid artery thrombus: Outcome with a strategy of initial anticoagulation. J Neurosurg 2013;118:34-41.  Back to cited text no. 4
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow