Recanalization and Remarkable Outcome after Subocclusive Thrombus: A Case Report

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...

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Published inJournal of stroke and cerebrovascular diseases Vol. 25; no. 3; pp. e28 - e30
Main Authors Nelson, Sarah, MD, Chung, David Y., MD, PhD, Rordorf, Guy, MD
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.03.2016
Subjects
Acute ischemic stroke
Aged, 80 and over
anticoagulation
Cardiovascular
computed tomography
Computed Tomography Angiography
Endovascular Procedures - methods
endovascular therapy
Fibrinolytic Agents
Humans
Intracranial Thrombosis - diagnostic imaging
Intracranial Thrombosis - surgery
intraluminal thrombus
Male
Neurology
subocclusive thrombus
Thrombolytic Therapy
Tomography, X-Ray Computed
Treatment Outcome
computed tomography
Acute ischemic stroke
subocclusive thrombus
intraluminal thrombus
endovascular therapy
anticoagulation
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Summary: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.
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
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ISSN:1052-3057
1532-8511
DOI:10.1016/j.jstrokecerebrovasdis.2015.11.024