Endovascular Approaches to Free Floating Carotid Thrombi
Endovascular Approaches to Free Floating Carotid Thrombi
Ischemic strokes are seldom caused by free floating thrombi (FFTs) in the carotid artery. Because FFTs are fairly uncommon and their pathophysiology has not yet been clarified, no definite management guidelines have been established. Four consecutive patients with FFTs in the internal and/or common carotid artery are described. These patients were successfully treated by various endovascular treatment methods.
Free floating thrombus (FFT) has been reported as a rare cause of ischemic stroke. FFTs usually show significant mobility with intact antegrade flow because parts are stuck to the injured arterial wall. Their instability may make them sources of recurrent artery to artery embolism. The most dreaded complication is detachment, resulting in complete occlusion of the distal cerebral arteries.
Because FFT is fairly uncommon, definite management guidelines have not yet been established. These are considered surgical emergencies, requiring immediate thrombectomy or treatment with anticoagulation therapy. Although medical and surgical management have both been successful, neither is clearly superior to the other.
The recent development of various endovascular devices and techniques has enabled individualized therapy for patients with FFTs. We describe various endovascular techniques that can be successfully applied for the treatment of FFTs in the carotid arteries.
Abstract and Introduction
Abstract
Ischemic strokes are seldom caused by free floating thrombi (FFTs) in the carotid artery. Because FFTs are fairly uncommon and their pathophysiology has not yet been clarified, no definite management guidelines have been established. Four consecutive patients with FFTs in the internal and/or common carotid artery are described. These patients were successfully treated by various endovascular treatment methods.
Introduction
Free floating thrombus (FFT) has been reported as a rare cause of ischemic stroke. FFTs usually show significant mobility with intact antegrade flow because parts are stuck to the injured arterial wall. Their instability may make them sources of recurrent artery to artery embolism. The most dreaded complication is detachment, resulting in complete occlusion of the distal cerebral arteries.
Because FFT is fairly uncommon, definite management guidelines have not yet been established. These are considered surgical emergencies, requiring immediate thrombectomy or treatment with anticoagulation therapy. Although medical and surgical management have both been successful, neither is clearly superior to the other.
The recent development of various endovascular devices and techniques has enabled individualized therapy for patients with FFTs. We describe various endovascular techniques that can be successfully applied for the treatment of FFTs in the carotid arteries.
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