Free-floating thrombus and a fragment of atherosclerotic plaque in the lumen of the internal carotid artery – review of 2 cases
| Autor: | O.A. Pastushyn, S.V. Konotopchyk, O.Ye. Svyrydiuk, M.Yu. Mamonova, I.I. Al-Kashkish, N.M. Nosenko, F.H. Rzayeva |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry medicine.medical_treatment R895-920 Carotid ultrasonography Lumen (anatomy) medicine.disease Medical physics. Medical radiology. Nuclear medicine key words: a free-floating thrombus a mobile plaque atherosclerotic plaque cerebral embolism ischemic stroke carotid artery stenosis cerebral angiography ultrasonography thrombectomy stenting Right Common Carotid Artery medicine.artery Angioplasty medicine cardiovascular diseases Radiology Internal carotid artery Thrombus business Endarterectomy Cerebral angiography |
| Zdroj: | Українська Інтервенційна Нейрорадіологія та Хірургія, Vol 35, Iss 1, Pp 56-65 (2021) |
| ISSN: | 2786-4863 2786-4855 |
| DOI: | 10.26683/2786-4855-2021-1(35)-56-65 |
| Popis: | Free-floating thrombus or a fragment of atherosclerotic plaque (mobile plaque) in the lumen of the carotid artery is extremely rare. Atherosclerosis is the most common cause underlying their occurrence. The optimal treatment strategy has not been developed, at least in part due to the rarity of observations, as well as the lack of comparative studies between conservative and surgical treatment (carotid artery stenting, endovascular thrombectomy, endarterectomy). We present two cases that demonstrate the treatment tactics of these rather rare pathologies. Patient Yu., 62 years old, was hospitalized with focal neurological symptoms, National Institutes of Health Stroke Scale of 12. According to the CT of the brain, signs of an ischemic stroke in the right middle cerebral artery circulation were detected. Selective cerebral angiography diagnosed thrombosis of the arteries of the precentral and central sulcus of the right middle cerebral artery, critical stenosis of the mouth of the right internal carotid artery, and a free-floating thrombus in its lumen with a fixation point at the level of atherosclerotic plaque, which blocked the lumen of the artery by more than 60 %. Endovascular aspiration of a free-floating thrombus was performed, followed by angioplasty and stenting of critical stenosis with a favorable clinical outcome. Patient L., 73 years old, applied for carotid ultrasonography, during which a mobile atherosclerotic plaque was diagnosed at the level of the bifurcation of the right common carotid artery. Digital selective cerebral angiography confirmed a plaque fragment floating in the lumen of the artery. After applying a loading dose of ticagrelor without complications, an emergency implantation of a carotid stent was performed at the level of the bifurcation of the right common carotid artery.Taking into account the modern possibilities of interventional radiology and a wide range of tools, the endovascular approach to the treatment of complicated atherosclerotic plaque with a floating component or a formed blood clot is the best treatment option with a good safety profile. |
| Databáze: | OpenAIRE |
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