TY - JOUR
T1 - Symptomatic patients with intraluminal carotid artery thrombus
T2 - Outcome with a strategy of initial anticoagulation - Clinical article
AU - Vellimana, Ananth K.
AU - Kadkhodayan, Yasha
AU - Rich, Keith M.
AU - Cross, Dewitte T.
AU - Moran, Christopher J.
AU - Zazulia, Allyson R.
AU - Lee, Jin Moo
AU - Chicoine, Michael R.
AU - Dacey, Ralph G.
AU - Derdeyn, Colin P.
AU - Zipfel, Gregory J.
PY - 2013/1
Y1 - 2013/1
N2 - Object. The aim of this study was to define the optimal treatment for patients with symptomatic intraluminal carotid artery thrombus (ICAT). Methods. The authors performed a retrospective chart review of patients who had presented with symptomatic ICAT at their institution between 2001 and 2011. Results. Twenty-four patients (16 males and 8 females) with ICAT presented with ischemic stroke (18 patients) or transient ischemic attack ([TIA], 6 patients). All were initially treated using anticoagulation with or without antiplatelet drugs. Eight of these patients had no or only mild carotid artery stenosis on initial angiography and were treated with medical management alone. The remaining 16 patients had moderate or severe carotid stenosis on initial angiography; of these, 10 underwent delayed revascularization (8 patients, carotid endarterectomy [CEA]; 2 patients, angioplasty and stenting), 2 refused revascularization, and 4 were treated with medical therapy alone. One patient had multiple TIAs despite medical therapy and eventually underwent CEA; the remaining 23 patients had no TIAs after treatment. No patient suffered ischemic or hemorrhagic stroke while on anticoagulation therapy, either during the perioperative period or in the long-term follow-up; 1 patient died of an unrelated condition. The mean follow-up was 16.4 months. Conclusions. Results of this study suggest that initial anticoagulation for symptomatic ICAT leads to a low rate of recurrent ischemic events and that carotid revascularization, if indicated, can be safely performed in a delayed manner.
AB - Object. The aim of this study was to define the optimal treatment for patients with symptomatic intraluminal carotid artery thrombus (ICAT). Methods. The authors performed a retrospective chart review of patients who had presented with symptomatic ICAT at their institution between 2001 and 2011. Results. Twenty-four patients (16 males and 8 females) with ICAT presented with ischemic stroke (18 patients) or transient ischemic attack ([TIA], 6 patients). All were initially treated using anticoagulation with or without antiplatelet drugs. Eight of these patients had no or only mild carotid artery stenosis on initial angiography and were treated with medical management alone. The remaining 16 patients had moderate or severe carotid stenosis on initial angiography; of these, 10 underwent delayed revascularization (8 patients, carotid endarterectomy [CEA]; 2 patients, angioplasty and stenting), 2 refused revascularization, and 4 were treated with medical therapy alone. One patient had multiple TIAs despite medical therapy and eventually underwent CEA; the remaining 23 patients had no TIAs after treatment. No patient suffered ischemic or hemorrhagic stroke while on anticoagulation therapy, either during the perioperative period or in the long-term follow-up; 1 patient died of an unrelated condition. The mean follow-up was 16.4 months. Conclusions. Results of this study suggest that initial anticoagulation for symptomatic ICAT leads to a low rate of recurrent ischemic events and that carotid revascularization, if indicated, can be safely performed in a delayed manner.
KW - Anticoagulation
KW - Carotid artery stenting
KW - Carotid artery thrombus
KW - Carotid endarterectomy
KW - Vascular disorders
UR - http://www.scopus.com/inward/record.url?scp=84872187993&partnerID=8YFLogxK
U2 - 10.3171/2012.9.JNS12406
DO - 10.3171/2012.9.JNS12406
M3 - Article
C2 - 23061393
AN - SCOPUS:84872187993
SN - 0022-3085
VL - 118
SP - 34
EP - 41
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 1
ER -