Symptomatic carotid artery intraluminal thrombus: risk of medical management failure and distal embolization.
| Autor: | Schartz D; Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA derrek_schartz@urmc.rochester.edu.; Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA., Susa S; Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA., Ellens N; Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA., Akkipeddi SMK; Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA., Houk C; Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA., Bhalla T; Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA., Mattingly T; Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA., Hasan D; Neurosurgery, Duke University, Durham, North Carolina, USA., Bender MT; Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Journal of neurointerventional surgery [J Neurointerv Surg] 2024 Dec 26; Vol. 17 (e1), pp. e55-e59. Date of Electronic Publication: 2024 Dec 26. |
| DOI: | 10.1136/jnis-2023-021044 |
| Abstrakt: | Background: Carotid artery intraluminal thrombus (ILT), or free-floating thrombus, is an uncommon cerebrovascular entity with considerable equipoise regarding its clinical management. Likewise, in patients treated with medical management (MM), distal embolization and/or intracranial hemorrhage (ICH) may still occur. Methods: All patients with symptomatic ILT from 2016 to 2023 were identified from our tertiary care institution. Patients with MM failure (recurrent cerebral ischemia and/or symptomatic ICH) were compared with patients with MM non-failure. Differences in ILT volume and length were calculated. Receiver operator characteristic (ROC) curve analysis was used to identify the cut-off volume and length for risk of MM failure. Results: In total, 45 patients with ILT were identified with 41 treated with frontline MM. Of these 41 patients treated with MM, seven (17%) had MM failure with six (14.6%) having new embolic stroke and one (2.3%) with symptomatic ICH. Patients with MM failure had a significantly higher mean thrombus volume than MM non-failure patients (257 mm 3 vs 59.6 mm 3 , P=0.0006). Likewise, patients with MM failure had significantly longer thrombus on average (21 mm vs 6.6 mm, P=0.0009). ROC curve analysis showed that an ILT volume of 90 mm 3 resulted in a sensitivity of 71.4% and specificity of 85.3% for MM failure (AUC 0.775; CI 0.55 to 1.0, P=0.023). Conclusions: Carotid ILTs that fail MM are significantly larger and longer. These findings suggest that a thrombus volume of 90 mm 3 may serve as a guide for intervention with good sensitivity and specificity for risk of MM failure. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.) |
| Databáze: | MEDLINE |
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