Emergent vs. elective stenting of carotid stenosis with intraluminal carotid thrombus.
OBJECTIVE
Carotid stenosis (CS) with intraluminal carotid artery thrombus (ICAT) is rare but ominous finding. The optimal treatment modality is unclear. The aim of this study was to analyze the feasibility and outcome of acute endovascular intervention and delayed elective endovascular therapy after initial anticoagulation in these delicate cases. Moreover, both treatment points were compared and several parameters discussed to facilitate the determination of the optimal time modality in future cases.


METHODS
A series of 11 consecutive cases with acute symptomatic CS with ICAT that received endovascular treatment was retrospectively analyzed. General patient data, pre and post-interventional symptoms and imaging were evaluated in an overall mean follow-up of 84 weeks.


RESULTS
Urgent stenting and mechanical thrombectomy was performed in 6 patients. In the remaining 5 cases, elective endovascular treatment was planned after initial anticoagulation therapy with thrombus resolution. One case received secondary urgent treatment due to clinical deterioration. Overall outcome at three months follow-up was excellent (Modified Ranking Scale [mRS] 0-1) in 5 cases, good (mRS 2) in 4 and unfavorable in the remaining 2. Important differences between the two treatment arms were seen in 3 parameters (stenosis degree, thrombus length, and NIHSS score).


CONCLUSIONS
This is one of the largest studies analysing endovascular treatment in patients with acute symptomatic CS and additional ICAT only. Both endovascular treatment strategies seem feasible. Parameters such as size of intraluminal thrombus and clinical symptoms should be included in the decision-making process regarding the optimal individual treatment time.
Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland.
Martin
M
Hlavica
Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland.
Jatta
J
Berberat
Brain Research Institute, University of Zurich and Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
Benjamin Victor
BV
Ineichen
Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland.
Javier
J
Añon
Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland.
Michael
M
Diepers
Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
Krassen
K
Nedeltchev
Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
Timo
T
Kahles
Department of Neuroradiology, Cantonal Hospital Aarau, Aarau, Switzerland. Electronic address: luca.remonda@ksa.ch.
Luca
L
Remonda
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D017558:Elective Surgical Procedures; D004630:Emergencies; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D017131:Thrombectomy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome
D000925:Anticoagulants
Acute; Carotid stenosis; Elective; Stenting; Thrombus