scholarly journals A Case of Coincidental Free Floating Thrombus in the Vertebral Artery in a Patient Presenting with an Anterior Circulation Stroke and Literature Review

2020 ◽  
Vol 15 (3) ◽  
pp. 144-153
Author(s):  
Hosam Al-Jehani ◽  
May Adel Alhamid ◽  
Yousef Alkhalaf ◽  
Faisal Alabbas
Keyword(s):  
Vertebral Artery ◽  
Internal Carotid ◽  
Case Reports ◽  
Rare Condition ◽  
Vascular Imaging ◽  
Unknown Etiology ◽  
Review Of The Literature ◽  
Anterior Circulation ◽  
Floating Thrombus ◽  
First Pass

Free-floating thrombus (FFT) is a rare condition with unknown etiology as described by many case reports presented in previous literature. The patients usually present symptomatically while the other few patients remain asymptomatic and are usually discovered incidentally on computed tomography angiography (CTA). Most of the cases reported in the literature are of FFT in the internal carotid artery. We present a 59-year-old female as a case of FFT in the vertebral artery which was coincidently discovered on CTA in a patient initially presenting with an anterior circulation stroke. This case highlights the importance of early contrast-based vascular imaging in patients presenting with large vessel strokes that are cardioembolic in nature and the unique utilization of a direct aspiration first pass technique (ADAPT) for revascularization. Included herein an extensive review of the literature about the decision making in patients with FFT and a devised proposed practical approach to this entity.

Free-Floating Thrombus in the Distal Internal Carotid Artery Causing a Stroke

2020 ◽  
Author(s):  
Spyros Papadoulas ◽  
Konstantinos Moulakakis ◽  
Natasa Kouri ◽  
Petros Zampakis ◽  
Stavros K. Kakkos
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Medical Management ◽  
Internal Carotid ◽  
Treatment Strategies ◽  
Rare Condition ◽  
Residual Stenosis ◽  
Floating Thrombus ◽  
Distal Internal Carotid Artery ◽  
Carotid Bulb

AbstractWe present a patient suffering from a stroke with a free-floating thrombus extending up to the distal internal carotid artery. The thrombus was totally resolved after a 2-week anticoagulation regimen without leaving behind any severe residual stenosis in the carotid bulb. The optimal treatment of this rare condition remains uncertain. We report some important treatment strategies that have been used in the literature, emphasizing the anticoagulation as the mainstay of therapy. Immediate surgical and interventional manipulations carry the risk of thrombus dislodgement and embolization and should be considered if there are recurrent symptoms despite medical management.

scholarly journals Erythromelanosis Follicularis Faciei et Colli: A Case Report in a Caucasian Male and Brief Review of the Literature

2020 ◽  
Vol 12 (3) ◽  
pp. 231-235
Author(s):  
Carl Maximilian Thielmann ◽  
Wiebke Sondermann
Keyword(s):  
Case Report ◽  
Family History ◽  
Clinical Presentation ◽  
Rare Condition ◽  
Unknown Etiology ◽  
Review Of The Literature ◽  
Caucasian Male

Erythromelanosis follicularis faciei et colli, a rare condition of unknown etiology, was first described by Kitamura et al. from Japan in 1960. It is characterized by a triad consisting of well-demarcated erythema, hyperpigmentation, and follicular papules. We report the case of a 50-year-old Caucasian male, who had asymptomatic symmetrical facial lesions since the age of 42. His family history was unremarkable. Published erythromelanosis follicularis faciei et colli cases of the last 10 years are summarized in this report to demonstrate the variability and differences in the clinical presentation of this uncommon diagnosis.

scholarly journals Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis

2020 ◽  
Vol 11 (5) ◽  
pp. 900-909 ◽  
Author(s):  
Aglaé Velasco Gonzalez ◽  
Dennis Görlich ◽  
Boris Buerke ◽  
Nico Münnich ◽  
Cristina Sauerland ◽  
...  
Keyword(s):  
Decision Tree ◽  
Internal Carotid ◽  
Primary Objective ◽  
Supervised Machine Learning ◽  
Anterior Circulation ◽  
Clot Removal ◽  
Guide Catheter ◽  
First Pass ◽  
Distal Internal Carotid Artery ◽  
The One

Abstract Complete recanalization after a single retrieval maneuver is an interventional goal in acute ischemic stroke and an independent factor for good clinical outcome. Anatomical biomarkers for predicting clot removal difficulties have not been comprehensively analyzed and await unused. We retrospectively evaluated 200 consecutive patients who suffered acute stroke and occlusion of the anterior circulation and were treated with mechanical thrombectomy through a balloon guide catheter (BGC). The primary objective was to evaluate the influence of carotid tortuosity and BGC positioning on the one-pass Modified Thrombolysis in Cerebral Infarction Scale (mTICI) 3 rate, and secondarily, the influence of communicating arteries on the angiographic results. After the first-pass mTICI 3, recanalization fell from 51 to 13%. The regression models and decision tree (supervised machine learning) results concurred: carotid tortuosity was the main constraint on efficacy, reducing the likelihood of mTICI 3 after one pass to 30%. BGC positioning was relevant only in carotid arteries without elongation: BGCs located in the distal internal carotid artery (ICA) had a 70% probability of complete recanalization after one pass, dropping to 43% if located in the proximal ICA. These findings demonstrate that first-pass mTICI 3 is influenced by anatomical and interventional factors capable of being anticipated, enabling the BGC technique to be adapted to patient’s anatomy to enhance effectivity.

scholarly journals Roadmap Guided Direct Percutaneous Vertebral Artery Puncture for Mechanical Thrombectomy of Acute Basilar Artery Occlusion: A Technical Case Report and Review of the Literature

2022 ◽  
Vol 12 ◽  
Author(s):  
Jawed Nawabi ◽  
Georg Bohner ◽  
Eberhard Siebert
Keyword(s):  
Vertebral Artery ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Target Vessel ◽  
Anterior Circulation ◽  
Direct Puncture ◽  
Safety Issues

Access techniques for mechanical thrombectomy normally include percutaneous puncture of the common femoral or, more recently, the radial artery. Although target vessel catheterization may frequently not be devoid of difficulties via both routes, the vast majority of mechanical thrombectomy (MT) cases can be successfully managed. However, in a significant minority of cases, a stable target vessel access cannot be reached resulting in futile recanalization procedures and detrimental outcomes for the patients. As such, in analogy to direct carotid puncture for anterior circulation MT, direct vertebral artery (VA) puncture (DVP) is a direct cervical approach, which can constitute the only feasible access to the posterior circulation in highly selected cases. So far, due to the rarity of DVP, only anecdotal evidence from isolated case reports is available and this approach raises concerns with regard to safety issues, feasibility, and technical realization. We present a case in which bail-out access to the posterior circulation was successfully obtained through a roadmap-guided lateral direct puncture of the V2 segment of the cervical VA and give an overview of technical nuances of published DVP approaches for posterior circulation MT.

Prevalence study of proximal vertebral artery stenosis using high‐resolution contrast‐enhanced magnetic resonance angiography

2005 ◽  
Vol 46 (3) ◽  
pp. 314-321 ◽  
Author(s):  
S. H. Kim ◽  
J. S. Lee ◽  
O. K. Kwon ◽  
M. K. Han ◽  
J. H. Kim
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vertebral Artery ◽  
Basilar Artery ◽  
Internal Carotid ◽  
Artery Stenosis ◽  
Anterior Circulation ◽  
Asymptomatic Group ◽  
Vertebral Artery Stenosis ◽  
Symptom Group

Purpose: To evaluate the prevalence of proximal vertebral artery stenosis, compared with those of the distal vertebral/basilar artery and extracranial internal carotid artery, in a large population of stroke and non‐stroke patients. Material and Methods: Nine‐hundred‐and‐thirty‐five patients who underwent high‐resolution contrast‐enhanced magnetic resonance angiography in a regional general hospital were categorized into six groups based on neurological symptoms and disease: an asymptomatic group ( n = 182), a minor symptom group with headache or dizziness ( n = 519), a cardiac group with coronary artery steno‐occlusive disease ( n = 15), a hemorrhagic group with old cerebral hemorrhage ( n = 26), an anterior circulation infarct group ( n = 121), and posterior circulation infarct group ( n = 72). Prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was analyzed. Results: The prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was 12.9%, 5.5%, and 7.2%, respectively, in the study population, and rose as the age increased ( P<0.0001 for all arteries). The prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was 3.3%, 0.5%, and 1.1%, respectively, in the asymptomatic group; 8.3%, 2.1%, and 3.7%, respectively, in the minor symptom group; 13.3%, 6.7%, and 6.7%, respectively, in the cardiac group; 19.2%, 7.7%, and 7.7%, respectively, in the hemorrhagic group; 27.3%, 8.3%, and 25.6%, respectively, in the anterior circulation infarct group; and 44.4%, 36.1%, and 16.7%, respectively, in the posterior circulation infarct group. This increasing tendency of stenosis accordingly was statistically significant ( P<0.0001 for all arteries). Conclusion: The prevalence of proximal vertebral artery stenosis was highest, compared with those of the distal vertebral/basilar artery and internal carotid artery, although the clinical significance of proximal vertebral artery stenosis should be investigated in further studies.

Free-floating thrombus of the carotid artery with a homozygous methylenetetrahydrofolate reductase gene mutation: a case report

Vascular ◽  
2011 ◽  
Vol 21 (1) ◽  
pp. 35-38
Author(s):  
Necmettin Colak ◽  
Yunus Nazli ◽  
Dilek Kosehan ◽  
Mehmet Fatih Alpay ◽  
Omer Cakir
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Methylenetetrahydrofolate Reductase ◽  
Rare Condition ◽  
Mthfr C677t ◽  
Symptomatic Patient ◽  
Left Common Carotid Artery ◽  
Unknown Etiology ◽  
Floating Thrombus ◽  
Aggressive Surgical Approach

Free-floating thrombus (FFT) of the carotid artery is a rare condition of currently unknown etiology. We describe a symptomatic patient with an FFT in the left common carotid artery. A duplex ultrasonography scan showed the presence of a mobile floating thrombus moving in cyclical motion with the cardiac cycles in the left common carotid artery. During emergency surgery, an FFT was seen at this location and removed. No underlying wall defect was seen at the time of surgery. In a genetic screening test, TT homozygous for the methylenetetrahydrofolate reductase (MTHFR) C677T genetic polymorphisms was detected. The patient recovered uneventfully, with no neurogical events. Lifelong anticoagulant therapy was recommended. An aggressive surgical approach is recommended in the patient to prevent embolic episodes.

Aphthous Vulvar Ulcers in Adolescent Girls: Case Report and Review of the Literature

2010 ◽  
Vol 14 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Kimberly Lai ◽  
Emily Lambert ◽  
Mary Gail Mercurio
Keyword(s):  
Adolescent Girls ◽  
Sexual Transmission ◽  
Rare Condition ◽  
Unknown Etiology ◽  
Review Of The Literature ◽  
Aphthous Ulcers ◽  
Common Causes ◽  
History Of ◽  
Systemic Symptoms ◽  
False Accusations

Background: Aphthous vulvar ulcers are painful ulcerations on the genital mucosa frequently accompanied by systemic symptoms. They are most commonly reported in young women and adolescents without a history of sexual contact. Diagnosis is made by exclusion of more common causes, and treatment for this self-limited condition is mainly symptomatic. Objective: Clinicians should be aware of this rare condition to avoid misdiagnoses and unwarranted investigations into sexual abuse or false accusations of sexual activity. Methods: We report a case of an 11-year-old girl with systemic symptoms and vulvar ulcers of unknown etiology. Results: The patient's illness was consistent with previous reports that vulvar ulcers can occur without sexual transmission or a documented infectious cause. Conclusion: A lack of general knowledge regarding this entity may lead to its exclusion from the differential diagnosis of vulvar ulcers in this patient population. Aphthous ulcers should be strongly considered in any adolescent with vulvar ulcers.

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