Clinical Information

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Society for Vascular Surgery

Mobile Carotid Thrombus
G. Matthew Longo, MD and Jon S. Matsumura, MD
Northwestern University, Chicago, IL
 


A 73-year-old male was noted to have a large, mobile lesion in the left carotid bulb during a surveillance carotid artery duplex examination. (Figure 1) At the time, he was asymptomatic. He had previously undergone two left carotid endarterectomies and had significant scarring of his left neck. On his right side was a chronically occluded right carotid artery, with a patent right subclavian to external carotid artery bypass. He also had significant coronary artery and peripheral vascular disease.

Figure 1. Duplex ultrasound demonstrating a mobile lesion in the left common carotid artery.

The patient was admitted to the hospital and anticoagulated. Discussions were undertaken weighing the options of redo carotid endarterectomy, medical management, and carotid artery stenting. After careful consideration, the patient elected to undergo stenting of the left carotid artery.

The following day, the patient was taken to the operating room. Using local anesthesia, a thoracic angiogram was performed, demonstrating the lesion. (Figure 2)

Figure 2. A selective left carotid artery angiogram demonstrating a mobile left common carotid artery lesion.

A PercuSurge cerebral protection device was placed with care taken not to disturb the lesion. (Figure 3)

Figure 3. Angiogram demonstrating stent placement with residual thrombus in the carotid artery. The black arrow denotes the cerebral protection device?s position.

With no predilatation prior to stent deployment, a 10x30 self-expanding nitinol stent was deployed, trapping the lesion. A repeat angiogram demonstrated residual thrombus, thus a second 8x20 stent was deployed. Completion angiography demonstrated a widely patent carotid artery with no residual thrombus. (Figure 4)

Figure 4. Completion angiogram demonstrating no residual thrombus in the carotid artery.

Cranial views failed to show any evidence of distal embolization. The patient did well and was discharged from the hospital on the second post-operative day.
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