Sebastian Fridman1, Stephen P Lownie2, Jennifer Mandzia1. 1. 1 Department of Clinical Neurological Sciences, Division of Neurology, University of Western Ontario, London, Canada. 2. 2 Department of Clinical Neurological Sciences, Division of Neurosurgery, University of Western Ontario, London, Canada.
Abstract
BACKGROUND: There is no consensus regarding the management of carotid free-floating thrombi in patients with acute ischemic stroke and transient ischemic attack. AIMS: This systematic review aims to (1) describe the current imaging methods for diagnosis of carotid free-floating thrombi and its associated risk factors, (2) estimate the proportion of carotid free-floating thrombi diagnosed in stroke patients, (3) estimate the proportion of carotid free-floating thrombi patients treated medically and surgically, and (4) evaluate 30-day outcomes. METHODS: We searched MEDLINE, EMBASE, and manually for references reporting carotid free-floating thrombi from 1960 until June 2017. We estimated the frequency of carotid free-floating thrombi and evaluated 30-day outcomes using Cox regression. We defined the timing of surgical intervention as early (less than 72 h) and delayed (more or equal to 72 h). SUMMARY OF REVIEW: We retrieved 525 carotid free-floating thrombi cases from 58 case series and 83 case reports. Carotid free-floating thrombi were present in 1.53% of stroke patients. Carotid free-floating thrombi diagnosis was made by digital subtraction angiography (38.1%), carotid duplex ultrasound (29.5%), and computed tomography angiography (29.5%). The 30-day risk of transient ischemic attack, silent brain ischemia, any stroke or death was 17.1%. In multivariate analyses, there were no differences in outcome for any anticoagulation regime or timing of revascularization procedure. CONCLUSIONS: The diagnosis of carotid free-floating thrombi is more common due to the increased use of early noninvasive vascular imaging in transient ischemic attack and stroke. It poses a high short-term risk of stroke and death, but there is as yet no established treatment. The low quality of evidence in the carotid free-floating thrombi literature limits the interpretation of our results and warrants a large-scale prospective cohort study in carotid free-floating thrombi.
BACKGROUND: There is no consensus regarding the management of carotid free-floating thrombi in patients with acute ischemic stroke and transient ischemic attack. AIMS: This systematic review aims to (1) describe the current imaging methods for diagnosis of carotid free-floating thrombi and its associated risk factors, (2) estimate the proportion of carotid free-floating thrombi diagnosed in strokepatients, (3) estimate the proportion of carotid free-floating thrombipatients treated medically and surgically, and (4) evaluate 30-day outcomes. METHODS: We searched MEDLINE, EMBASE, and manually for references reporting carotid free-floating thrombi from 1960 until June 2017. We estimated the frequency of carotid free-floating thrombi and evaluated 30-day outcomes using Cox regression. We defined the timing of surgical intervention as early (less than 72 h) and delayed (more or equal to 72 h). SUMMARY OF REVIEW: We retrieved 525 carotid free-floating thrombi cases from 58 case series and 83 case reports. Carotid free-floating thrombi were present in 1.53% of strokepatients. Carotid free-floating thrombi diagnosis was made by digital subtraction angiography (38.1%), carotid duplex ultrasound (29.5%), and computed tomography angiography (29.5%). The 30-day risk of transient ischemic attack, silent brain ischemia, any stroke or death was 17.1%. In multivariate analyses, there were no differences in outcome for any anticoagulation regime or timing of revascularization procedure. CONCLUSIONS: The diagnosis of carotid free-floating thrombi is more common due to the increased use of early noninvasive vascular imaging in transient ischemic attack and stroke. It poses a high short-term risk of stroke and death, but there is as yet no established treatment. The low quality of evidence in the carotid free-floating thrombi literature limits the interpretation of our results and warrants a large-scale prospective cohort study in carotid free-floating thrombi.
Authors: Zachary K Christian; Alex N Hoang; Huy Dang; Abdul B Khan; Daniel M S Raper; Zachary S Pallister; Omar Tanweer Journal: J Neurosurg Case Lessons Date: 2022-03-07
Authors: Mandy D Müller; Nikolaos Raptis; Pasquale Mordasini; Werner Z'Graggen; Andreas Raabe; Philippe Schucht; Mirjam R Heldner; David Bervini Journal: Front Neurol Date: 2022-09-27 Impact factor: 4.086
Authors: Susana Cancer-Perez; Jesús Alfayate-García; Sandra Vicente-Jiménez; Manuel Ruiz-Muñoz; Fanny Patricia Dhimes-Tejada; Miguel Gutiérrez-Baz; Fernando Criado-Galan; Miryam Perera-Sabio; Luis de Benito-Fernández Journal: Ann Vasc Surg Date: 2021-03-06 Impact factor: 1.466