Preocclusive carotid artery thrombosis: Pathogenesis and management

In this report, the authors review the presentations, angiographic findings , and outcomes of eight cases involving patients who had atherosclerotic co mpromise of the proximal internal carotid artery and were developing distal thrombosis. They discuss the pathogenesis and implications of such lesions and review the management strategy used at this institution. Between 1994 and 1995, 606 consecutive patients underwent carotid endarterectomy (CEA) a t this institution. Among this group, four consecutive patients (0.66%, 4/6 06) were identified by angiography to have preocclusive carotid artery thro mbosis. An additional four patients with the same radiologic finding who ha d presented between 1980 and 1993 were also identified and included in this series. All eight patients were treated with anticoagulation and emergent CEA and thrombectomy. Complete resolution of presenting symptoms and freedo m from perioperative stroke and death were achieved in seven patients (88%, 7/8). In one patient (12%, 1/8) the perioperative course was complicated b y development of a carotid artery-cavernous sinus fistula and stroke. The c atastrophic potential of preocclusive carotid artery thrombosis mandates im mediate intervention. Anticoagulation, CEA, and thrombectomy can result in freedom from the adverse outcomes of stroke and death. However, special car e must accompany thrombectomy in order to avoid complications and their ass ociated morbidity.