Symptomatic patients with intraluminal carotid artery thrombus: outcome with a strategy of initial anticoagulation

Clinical article

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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.

Abbreviations used in this paper:CAS = carotid artery stenting; CEA = carotid endarterectomy; CTA = CT angiography; DSA = digital subtraction angiography; ICA = internal carotid artery; ICAT = intraluminal carotid artery thrombus; IQR = interquartile range; LMWH = low-molecular-weight heparin; MRA = MR angiography; NASCET = North American Symptomatic Carotid Endarterectomy Trial; NIHSS = NIH Stroke Scale; TIA = transient ischemic attack; UFH = unfractionated heparin.
Article Information

Contributor Notes

Address correspondence to: Gregory J. Zipfel, M.D., Washington University School of Medicine in St. Louis, Campus Box 8057, 660 South Euclid Avenue, St. Louis, Missouri 63110. email: zipfelg@wustl.edu.Please include this information when citing this paper: published online October 12, 2012; DOI: 10.3171/2012.9.JNS12406.
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