title: [Intraluminal Thrombus in Internal Carotid Artery Successfully Treated with Adjuvant Anticoagulant Therapy Followed by Carotid Endarterectomy:A Case Report].
abstract: BACKGROUND
  An intraluminal thrombus in the carotid artery is relatively rare. A high frequency of perioperative symptomatic stroke has been reported in patients undergoing carotid endarterectomy, and no standard therapy has yet been developed.
  
  
  METHODS
  A 69-year-old woman, with no history of trauma, presented with ischemic stroke and mild right hemiparesis. Computed tomography and MRI showed an infarction in the left parietal region. A carotid Doppler study showed carotid stenosis on the left side. Further investigation with digital subtraction angiography confirmed significant carotid artery stenosis with an intraluminal thrombus in the left internal carotid artery. She was treated with initial intravenous anticoagulant therapy followed by carotid endarterectomy with thrombus removal 14 days after admission(subacute phase). There was no postoperative complication and she had uneventful course over 3 years of follow-up.
  
  
  CONCLUSIONS
  Initial adjuvant anticoagulant therapy for symptomatic intraluminal thrombus followed by carotid revascularization is an effective surgical strategy. A meticulous surgical procedure is required to perform a carotid endarterectomy in patients with an intraluminal thrombus.
authors.affiliation: Department of Neurosurgery, Ishikawa Prefectural Central Hospital.
authors.forename: Hisato
authors.initials: H
authors.lastname: Minamide
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Megumi
authors.initials: M
authors.lastname: Ueno
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000187:drug effects; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D002533:Cerebral Angiography; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D010875:Pipecolic Acids / Q000627:therapeutic use*; D013449:Sulfonamides; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D010875:Pipecolic Acids; D013449:Sulfonamides; D001120:Arginine; C031942:argatroban