RT Journal Article
SR Electronic
T1 Aetiology of extracranial carotid free-floating thrombus in a prospective multicentre cohort
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 194
OP 196
DO 10.1136/svn-2022-001639
VO 8
IS 3
A1 Dowlatshahi, Dar
A1 Lum, Cheemun
A1 Menon, Bijoy K
A1 Bharatha, Aditya
A1 Dave, Prasham
A1 Puac-Polanco, Paulo
A1 Blacquiere, Dylan
A1 Stotts, Grant
A1 Shamy, Michel
A1 Momoli, Franco
A1 Thornhill, Rebecca
A1 Lun, Ronda
A1 Torres, Carlos
YR 2023
UL http://svn.bmj.com/content/8/3/194.abstract
AB Background Carotid free-floating thrombi (FFT) in patients with acute transient ischaemic attack (TIA)/stroke have a high risk of early recurrent stroke. Management depends on aetiology, which can include local plaque rupture, dissection, coagulopathy, malignancy and cardioembolism. Our objectives were to classify the underlying aetiology of FFT and to estimate the proportion of patients with underlying stenosis requiring revascularisation.Methods We prospectively enrolled consecutive patients presenting to three comprehensive stroke centres with acute TIA/stroke and ipsilateral internal carotid artery FFT. The aetiology of FFT was classified as: carotid atherosclerotic disease, carotid dissection, cardioembolism, both carotid atherosclerosis and cardioembolism, or embolic stroke of uncertain source (ESUS). Patients with carotid atherosclerosis were further subclassified as having ≥50% or <50% stenosis.Results We enrolled 83 patients with confirmed FFT. Aetiological assessments revealed 66/83 (79.5%) had carotid atherosclerotic plaque, 4/83 (4.8%) had a carotid dissection, 10/83 (12%) had both atrial fibrillation and carotid atherosclerotic plaque and 3/83 (3.6%) were classified as ESUS. Of the 76 patients with atherosclerotic plaque (including those with atrial fibrillation), 40 (52.6%) had ≥50% ipsilateral stenosis.Conclusions The majority of symptomatic carotid artery FFT are likely caused by local plaque rupture, more than half of which are associated with moderate to severe carotid stenosis requiring revascularisation. However, a significant number of FFTs are caused by non-atherosclerotic mechanisms warranting additional investigations.Data are available on reasonable request.