Endovascular Treatment of Acute Stroke due to the Floating Carotid Thrombus with Intra-Arterial Tissue Plasminogen Activator and Stenting

Year 2015, , 142 - 146, 09.10.2015

Enes Duman

https://doi.org/10.17826/cutf.39346

Abstract

54-year-old male patient was admitted to emergency service with bilateral loss of sight, consciousness and a Glasgow Coma Scale score of 15. His neurologic examination revealed no lateralized deficit but left homonymous hemianopia. Brain CT and diffusion MRI showed acute infarction in the right parietal and occipital lobes. There was a wide penumbra region on brain perfusion CT. The selective angiography showed preocclusive stenosis at the origin of right internal carotid artery (ICA) and massive floating thrombus (FT) in the cervical ICA segment.We report successful endovascular treatment of FT in the ICA using intra-arterial tissue plasminogen activator and stenting.

Keywords

Floating thrombus, tPA, endovascular stent placement, carotid stenosis

Hareketli Karotis Trombüsüne Bağlı Akut Strokun Stentleme ve İntra-arteryel Doku Plazminojen Aktivatörü ile Endovasküler Tedavis

Abstract

54 yaşında Glasgow koma skala skoru 15 olan erkek hasta acil servise bilateral görme kaybı, bilinç kaybı şikayeti ile başvurdu. Nörolojik muayenesinde lateralizasyon bulgusu izlenmeyen hastanın sol homonymous hemianopia’ sı mevcuttu. Beyin tomografisi ve beyin difüzyon MRG’ sinde sağ parietal ve oksipital lobda akut enfarkt saptandı. Perfüzyon BT tetkikinde geniş penumbra (kurtarılabilir alan- mismatch) alanı izlendi. Selektif karotit anjiyografi tetkikinde sağ internal karotit arter orjininde preokluziv darlık ve masif floating thrombus izlendi. Bu vakada intraarteriyel tPA ve stent kullanarak floating trombüsün başarılı endovasküler tedavisini paylaştık.

Keywords

Floating trombüs, tPA, endovasküler stent yerleştirilmesi, karotit darlığı

References

• Ahmad F, Bhatti, Luis R. Leon, Nicos Labropoulos, et.al. Free-floating thrombus of the carotid artery: literature review and case reports. J Vasc Surg. 2007;45:199-205.
• Sallustio F, Di Legge S, Marziali S, Ippoliti A, Stanzione P. Floating carotid thrombus treated by intravenous heparin and endarterectomy. J Vasc Surg. 2011;53-2:489-91.
• Tsumoto T, Terada T, Tsuura M, et.al. Carotid artery stenting for stenosis with intraluminal thrombus. Neuroradiology. 2006; 48-1:54-9.
• Sugg RM, Malkoff MD, Noser EA, et al. Endovascular recanalization of internal carotid artery occlusion in acute ischemic stroke. AJNR Am J Neuroradiol. 2005; 26-10:2591-4. patients with acute ischemic stroke: a treatment to be used in the context of randomized trials only. Stroke. 2001;32:579.
• Gubitz G, Counsell C, Sandercock P, Signorini D. Anticoagulants for acute ischemic stroke. Cochrane Database Syst Rev. 2000;2:CD000024.
• Swanson RA. Intravenous heparin for acute stroke: what can we learn from megatrials? Neurology 1999;52:1746-50.
• Coull BM, Williams LS, Goldstein LB, et al. Anticoagulants and antiplatelet agents in acute ischemic stroke: report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a Division of the American Heart Association). Stroke, 2002;33:1934-42.
• Skeik N, Gits CC, Ehrenwald E, Cragg AH. Fibrinogen level as a surrogate for the outcome of thrombolytic therapy using tissue plasminogen activator for acute lower extremity intravascular thrombosis. Vasc Endovascular Surg. 2013;47-7:519- 23.