Case report: Ultrasound-Assisted endovascular therapy for carotid artery floating thrombus
BackgroundCarotid free-floating thrombus (CFFT) is a rare but sometimes emergent condition. There has been controversy over the optimal treatment strategy. Emerging evidence suggests that endovascular thrombectomy (EVT) may be an alternative to surgery. Accurate alignment of the aspiration catheter...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.961760/full |
| _version_ | 1811269766127550464 |
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| author | Peng Wang Zhenzhen Wang Jie Pan Kefeng Lu Litao Sun Yu Geng |
| author_facet | Peng Wang Zhenzhen Wang Jie Pan Kefeng Lu Litao Sun Yu Geng |
| author_sort | Peng Wang |
| collection | DOAJ |
| description | BackgroundCarotid free-floating thrombus (CFFT) is a rare but sometimes emergent condition. There has been controversy over the optimal treatment strategy. Emerging evidence suggests that endovascular thrombectomy (EVT) may be an alternative to surgery. Accurate alignment of the aspiration catheter and thrombus during EVT is critical but has, so far, remained unresolved.Case summaryThis is a rare case of CFFT presenting with acute right-sided facial droop and moderate dysarthria in a 77-year-old man. He was in sinus rhythm with a blood pressure of 110/82 mmHg. Both non-contrast CT (NCCT) and head CT angiography (CTA) were unremarkable, while whole-brain CT perfusion (WB-CTP) suggested left hemisphere core infarction. Delayed imaging of the left internal carotid system by 4D-CTA suggested severe proximal obstructive disease, as confirmed by carotid CTA and ultrasonography. The initial two aspirations under DSA were invalid due to the challenging anatomical angle between the thrombus and the catheter. The success of CFFT removal was achieved with a pressure-assisted ultrasound-guided approach that helps to compress the catheter tip toward the thrombus.ConclusionWe innovatively report a successful ultrasound-guided EVT for CFFT. Ultrasound assistance can provide quick and effective guidance and may guide tailored aspirations during EVT. |
| first_indexed | 2024-04-12T21:47:57Z |
| format | Article |
| id | doaj.art-d4f65c390cd04ea7923ce6bfc17bb491 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-12T21:47:57Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-d4f65c390cd04ea7923ce6bfc17bb4912022-12-22T03:15:34ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-09-01910.3389/fcvm.2022.961760961760Case report: Ultrasound-Assisted endovascular therapy for carotid artery floating thrombusPeng Wang0Zhenzhen Wang1Jie Pan2Kefeng Lu3Litao Sun4Yu Geng5Department of Neurology, Center for Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, ChinaUltrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, ChinaDepartment of Neurology, Center for Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, ChinaUltrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, ChinaUltrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, ChinaDepartment of Neurology, Center for Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, ChinaBackgroundCarotid free-floating thrombus (CFFT) is a rare but sometimes emergent condition. There has been controversy over the optimal treatment strategy. Emerging evidence suggests that endovascular thrombectomy (EVT) may be an alternative to surgery. Accurate alignment of the aspiration catheter and thrombus during EVT is critical but has, so far, remained unresolved.Case summaryThis is a rare case of CFFT presenting with acute right-sided facial droop and moderate dysarthria in a 77-year-old man. He was in sinus rhythm with a blood pressure of 110/82 mmHg. Both non-contrast CT (NCCT) and head CT angiography (CTA) were unremarkable, while whole-brain CT perfusion (WB-CTP) suggested left hemisphere core infarction. Delayed imaging of the left internal carotid system by 4D-CTA suggested severe proximal obstructive disease, as confirmed by carotid CTA and ultrasonography. The initial two aspirations under DSA were invalid due to the challenging anatomical angle between the thrombus and the catheter. The success of CFFT removal was achieved with a pressure-assisted ultrasound-guided approach that helps to compress the catheter tip toward the thrombus.ConclusionWe innovatively report a successful ultrasound-guided EVT for CFFT. Ultrasound assistance can provide quick and effective guidance and may guide tailored aspirations during EVT.https://www.frontiersin.org/articles/10.3389/fcvm.2022.961760/fullfree-floating thrombus of the carotidendovascular thrombectomycarotid endarterectomycarotid angioplasty and stentingultrasound-guided intervention |
| spellingShingle | Peng Wang Zhenzhen Wang Jie Pan Kefeng Lu Litao Sun Yu Geng Case report: Ultrasound-Assisted endovascular therapy for carotid artery floating thrombus Frontiers in Cardiovascular Medicine free-floating thrombus of the carotid endovascular thrombectomy carotid endarterectomy carotid angioplasty and stenting ultrasound-guided intervention |
| title | Case report: Ultrasound-Assisted endovascular therapy for carotid artery floating thrombus |
| title_full | Case report: Ultrasound-Assisted endovascular therapy for carotid artery floating thrombus |
| title_fullStr | Case report: Ultrasound-Assisted endovascular therapy for carotid artery floating thrombus |
| title_full_unstemmed | Case report: Ultrasound-Assisted endovascular therapy for carotid artery floating thrombus |
| title_short | Case report: Ultrasound-Assisted endovascular therapy for carotid artery floating thrombus |
| title_sort | case report ultrasound assisted endovascular therapy for carotid artery floating thrombus |
| topic | free-floating thrombus of the carotid endovascular thrombectomy carotid endarterectomy carotid angioplasty and stenting ultrasound-guided intervention |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.961760/full |
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