BACKGROUND: Intraluminal free floating thrombus (FFT) of the cervical internal carotid artery (ICA) is a potentially high-risk lesion for recurrent ischemic strokes, with no single optimal treatment established. OBJECTIVE: To describe a novel interventional technique for mechanical thrombectomy of intraluminal free floating thrombus using a distal protection filter device and aspiration. METHODS: We identified two cases where anticoagulation was contraindicated in patients with intraluminal FFT and minimal underlying stenosis. In both cases, a distal protection device was used to extract the thrombus under proximal flow arrest and aspiration. RESULTS: Mechanical thrombectomy was successful in both cases, one with "en bloc" removal of the thrombus and one with piecemeal removal. Neither case showed any residual angiographic stenosis or atherosclerotic disease. CONCLUSION: Mechanical thrombectomy using a distal protection device is a novel and technically feasible approach for select cases of cervical intraluminal thrombus. This may represent a therapeutic option in select cases with high risk of anticoagulation and in the unusual subset of younger patients with minimal atherosclerotidc disease.
BACKGROUND: Intraluminal free floating thrombus (FFT) of the cervical internal carotid artery (ICA) is a potentially high-risk lesion for recurrent ischemic strokes, with no single optimal treatment established. OBJECTIVE: To describe a novel interventional technique for mechanical thrombectomy of intraluminal free floating thrombus using a distal protection filter device and aspiration. METHODS: We identified two cases where anticoagulation was contraindicated in patients with intraluminal FFT and minimal underlying stenosis. In both cases, a distal protection device was used to extract the thrombus under proximal flow arrest and aspiration. RESULTS: Mechanical thrombectomy was successful in both cases, one with "en bloc" removal of the thrombus and one with piecemeal removal. Neither case showed any residual angiographic stenosis or atherosclerotic disease. CONCLUSION: Mechanical thrombectomy using a distal protection device is a novel and technically feasible approach for select cases of cervical intraluminal thrombus. This may represent a therapeutic option in select cases with high risk of anticoagulation and in the unusual subset of younger patients with minimal atherosclerotidc disease.
Authors: Ahmad F Bhatti; Luis R Leon; Nicos Labropoulos; Tara L Rubinas; Heron Rodriguez; Peter G Kalman; Michael Schneck; S Benn Psalms; Jose Biller Journal: J Vasc Surg Date: 2007-01 Impact factor: 4.268
Authors: G G Ferguson; M Eliasziw; H W Barr; G P Clagett; R W Barnes; M C Wallace; D W Taylor; R B Haynes; J W Finan; V C Hachinski; H J Barnett Journal: Stroke Date: 1999-09 Impact factor: 7.914
Authors: Ananth K Vellimana; Yasha Kadkhodayan; Keith M Rich; DeWitte T Cross; Christopher J Moran; Allyson R Zazulia; Jin-Moo Lee; Michael R Chicoine; Ralph G Dacey; Colin P Derdeyn; Gregory J Zipfel Journal: J Neurosurg Date: 2012-10-12 Impact factor: 5.115