Progress on diagnosis and treatment of carotid free - floating thrombous related ischemic stroke

doi:10.3969/j.issn.1672-6731.2023.07.013

Abstract

Abstract:

Carotid free-floating thrombus (CFFT) is significantly associated with ischemic stroke. Thrombosis occludes the artery or falls off, leading to massive cerebral infarction or multiple embolism. In severe cases, cerebral hernia or even death may occur. The diagnosis of CFFT is gradually based on CT angiography (CTA). Early identification can help in etiological treatment. This article reviews the progress of the diagnosis and treatment of CFFT, in order to improve chinical diagnosis and treatment.

Key words: Carotid stenosis, Thrombosis, Stroke, Brain ischemia, Computed tomography angiography, Review

摘要：

颈动脉漂浮血栓与缺血性卒中显著相关，血栓闭塞动脉或脱落致大面积脑梗死或多发栓塞，严重者可出现脑疝甚至死亡，其诊断逐渐以CTA为主，早期识别有助于病因治疗。本文综述颈动脉漂浮血栓的诊断与治疗进展，以提高临床诊断与治疗水平。

关键词: 颈动脉狭窄, 血栓形成, 卒中, 脑缺血, 计算机体层摄影血管造影术, 综述

Shu-feng YU, Ning LI, Jian XU, Peng WANG. Progress on diagnosis and treatment of carotid free - floating thrombous related ischemic stroke[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(7): 638-642.

俞淑凤, 李宁, 徐健, 王鹏. 颈动脉漂浮血栓相关缺血性卒中诊断与治疗进展[J]. 中国现代神经疾病杂志, 2023, 23(7): 638-642.

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URL: http://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2023.07.013

http://journal11.magtechjournal.com/cjcnn/EN/Y2023/V23/I7/638

Figures/Tables 2

Figure 1 A 79-year-old male was admitted to the hospital with numbness and weakness of the left limb combined with slurred speech for 8 days. The clinical diagnosis was right cerebral infarction and floating thrombosis of the right CCA bifurcation, was treated with aspirin 100 mg/d and clopidogrel 75 mg/d. CTA findings before and after treatment Sagittal (Panel 1a) and axial (Panel 1b) MIP reconstruction before treatment showed floating thrombus in the carotid artery (arrows indicate). Sagittal (Panel 1c) and axial (Panel 1d) MIP reconstruction at one month after treatment showed floating thrombus disappearance.

Figure 2 A 77-year-old male was admitted to the hospital with weakness and numbness of the right upper limb for 16 hours. The clinical diagnosis was left cerebral infarction and floating thrombus in the left ICA, and was treated with endovascular therapy. Imaging findings before and after treatment Sagittal MIP reconstruction before treatment showed floating thrombus in the carotid artery (arrow indicates, Panel 2a). Axial MIP reconstruction before treatment showed typical "donut sign", suggesting floating thromlous in the carotid artery (arrows indicate; Panel 2b, 2c). DSA before treatment showed filling defect in the carotid artery (arrow indicates, Panel 2d). DSA after treatment showed filling defect disappearance in the carotid artery (Panel 2e).

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