Journal of Neurosciences in Rural Practice
Year : 2019  |  Volume : 10  |  Issue : 2  |  Page : 312-315

Symptomatic extracranial carotid artery thrombus: An Indian experience

Division of Stroke and Interventional Neurology and Department of Neurology, NH Institute of Neurosciences, Narayana Health City, Bengaluru, Karnataka, India

Correspondence Address:
Vikram Huded
Division of Stroke and Interventional Neurology and Department of Neurology, Narayana Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Narayana Health City, 258/A, Bommasandra Industrial Area, Hosur Main Road, Bengaluru - 560 099, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnrp.jnrp_225_18

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Introduction: Symptomatic intraluminal carotid artery thrombus (ICT) is an uncommon finding, whose incidence increases with the percentage of stenosis. The optimal treatment modality to address carotid artery thrombus is not well established. We present our data of medical management of carotid artery thrombus with antiplatelet and anticoagulation. Methods: We reviewed our data from January 1, 2016 to December 31, 2017. Patients with extracranial carotid artery thrombus underwent a catheter digital subtraction angiogram to confirm the presence of thrombus. Medical management was done with dual antiplatelets along with low-molecular-weight heparin, and a check angiogram was done after 14 days. Factors contributing to the persistence of thrombus were analyzed. Results: A total of 21 patients diagnosed with acute ischemic stroke and extracranial carotid artery thrombus. Three patients opted for endarterectomy. Eighteen patients underwent medical management. Nine (50%) had a resolution of thrombus. Those with persistent thrombus were significantly older (average age 64 vs. 43 years, P = 0.008). They also had significantly higher proportions of hypertension (100% vs. 44%, P = 0.029), diabetes mellitus (89% vs. 11%, P = 0.003), and underlying carotid stenosis (100% vs. 33%, P = 0.009). Conclusion: Our regimen of dual antiplatelets plus short-term anticoagulation is safe and effective in the management of ICT. Large-scale studies are warranted to determine the optimal regimen and duration of medical treatment.

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