Ravi Mareedu1, Jason Hwang2, Sudhir Vyakaranam3, Sashi Inkollu4. 1. Department of Cardiology, Ascension All Saints, Racine, WI, USA. 2. Department of Vascular Surgery, West Virginia University, Morgantown, WV, USA. 3. Nephrology Phys LLC, Mishawaka, IN/IU School of Medicine-South Bend Campus, Indiana, USA. 4. Department of Vascular Surgery, Marshfield Clinic Health System, Marshfield, WI, USA. Electronic address: Inkollu.sashi@marshfieldclinic.org.
Abstract
BACKGROUND: Free-floating thrombus in the internal carotid artery (ICA) has traditionally been treated via an open surgical approach through a longitudinal incision and exposure similar to that for carotid endarterectomy (CEA). In this case report, we present a novel use of transcarotid artery revascularization (TCAR) for the treatment of recurrent carotid stenosis associated with free-floating ICA thrombus. CASE DESCRIPTION: We describe a 67-year-old female who presented with a diagnosis of right hemispheric stroke in evolution and prior history of right CEA and a mechanical mitral valve. Imaging confirmed high-grade recurrent stenosis of the right ICA with free-floating thrombus. TCAR was utilized to repair both the recurrent stenosis and the thrombus. CONCLUSIONS: Redo CEA in the face of recurrent stenosis is a challenging clinical scenario, which in this instance, was further complicated by the presence of free-floating thrombus and active anticoagulation due to a mechanical mitral valve. This case report describes the successful management of ICA thrombus and restenosis with the novel use of TCAR.
BACKGROUND: Free-floating thrombus in the internal carotid artery (ICA) has traditionally been treated via an open surgical approach through a longitudinal incision and exposure similar to that for carotid endarterectomy (CEA). In this case report, we present a novel use of transcarotid artery revascularization (TCAR) for the treatment of recurrent carotid stenosis associated with free-floating ICA thrombus. CASE DESCRIPTION: We describe a 67-year-old female who presented with a diagnosis of right hemispheric stroke in evolution and prior history of right CEA and a mechanical mitral valve. Imaging confirmed high-grade recurrent stenosis of the right ICA with free-floating thrombus. TCAR was utilized to repair both the recurrent stenosis and the thrombus. CONCLUSIONS: Redo CEA in the face of recurrent stenosis is a challenging clinical scenario, which in this instance, was further complicated by the presence of free-floating thrombus and active anticoagulation due to a mechanical mitral valve. This case report describes the successful management of ICA thrombus and restenosis with the novel use of TCAR.
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