Surgical thromboendarterectomy for free-floating thrombus associated with cervical carotid artery dissection: A case report.

BACKGROUND Free-floating thrombus (FFT) of the cervical carotid artery is a rare but critical condition leading to stroke. The most common underlying pathology is atherosclerotic plaque; non-atherosclerotic pathologies are much rarer. Here we report a case of FFT associated with cervical carotid artery dissection that was successfully treated by surgical thromboendarterectomy. CASE DESCRIPTION A 51-year-old man presented with headache, the left neck pain, and amaurosis fugax. Magnetic resonance angiography revealed mild stenosis in the bifurcation of the left carotid artery. The stenotic lesion was considered as a possible dissection because of the normal appearance of the vessel 2 years ago and its clinical presentation. Oral aspirin was initiated with the diagnosis of transient ischemic attack. Two weeks later, ultrasound was planned for further examination, which demonstrated a massive FFT with intramural hematoma in the lesion. Since FFT was present despite taking aspirin, surgical thromboendarterectomy was performed to prevent further ischemic events. Intraoperative findings revealed that FFT was the thrombus protruding from the intramural hematoma caused by arterial dissection. After the whole dissected layer was removed, the residual lumen was reinforced by multiple tacking sutures to prevent recurrence of dissection. No further ischemic events and recurrence occurred during the 1-year of follow-up after the surgery. CONCLUSIONS When managing patients with carotid artery dissection, the formation of FFT should be considered as a possible critical feature. Surgical thromboendarterectomy with intimal tacking sutures might be an option for the treatment, ensuring immediate, preventive effects against the risk of cerebral embolism.

• Publication year

  2020

• Venue

  Annals of Vascular Surgery

• Publication date

  2020-05-18

• Fields of study

  Medicine

• Identifiers
  DOI 10.1016/j.avsg.2020.04.076PMID 32439523
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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