title: Recanalization and Remarkable Outcome after Subocclusive Thrombus: A Case Report.
abstract: Minimal literature exists regarding subocclusive thrombi and their management in acute ischemic stroke, and no randomized trials or guidelines are currently available. We present the case of an 83-year-old man with multiple vascular risk factors and recent cardiac surgery who presented with a severe left middle cerebral artery (MCA) syndrome due to a subocclusive thrombus. Intravenous (IV) tissue plasminogen activator was contraindicated given the patient's recent surgery, and endovascular therapy was deferred given improvement in symptoms. He was placed on IV heparin. His symptoms improved with recanalization of the MCA. Optimal management of subocclusive thrombi, which appear to have better outcomes than occlusive thrombi, has yet to be elucidated. Acute anticoagulation and endovascular therapy may both be reasonable; however, there are minimal data supporting the use of either and further studies are needed to develop the most favorable treatment algorithm. In the meantime, management decisions should be made on a case-by-case basis by multidisciplinary care teams.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: senelson13@gmail.com.
authors.forename: Sarah
authors.initials: S
authors.lastname: Nelson
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: David Y
authors.initials: DY
authors.lastname: Chung
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Guy
authors.initials: G
authors.lastname: Rordorf
mesh_terms: D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000379:methods*; D005343:Fibrinolytic Agents; D006801:Humans; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Acute ischemic stroke; anticoagulation; computed tomography; endovascular therapy; intraluminal thrombus; subocclusive thrombus