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Acute Carotid Artery Thrombosis: Description of 12 Surgically Treated Cases

  • Clinical Research
  • Published:
Annals of Vascular Surgery

Abstract

The morbidity and mortality of stroke secondary to acute internal carotid artery thrombosis range from 40 to 69% and from 15 to 55%, respectively, after purely medical treatment. This report describes a series of 12 patients who underwent urgent surgical treatment for primary acute carotid artery thrombosis between January 1999 and December 2002. Upon admission, all patients had severe neurologic deficits contralateral to carotid artery thrombosis. One patient experienced ongoing changes in the level of consciousness. The interval between the onset of symptoms and admission was less than 6 hr in all cases. Initial work-up in all patients included a brain computed tomographic scan with contrast injection and carotid duplex scan. The operative procedure consisted of carotid thomboemdarterectomy after shunt placement with prosthetic patch closure. Intraoperative angiography was performed in all cases. Following treatment, we observed deterioration of neurologic status leading to death in one case; improvement with partial regression of initial neurologic deficit in two cases, including one patient who died from causes unrelated to carotid artery disease; and full neurologic recovery in nine cases. The delay to revascularization was longer than 6 hr in both patients who died. These data support surgical intervention for carotid artery thrombosis in selected patients without major disturbances of consciousness or hemorragic infarction, provided that the delay to revascularization is less than 6 hr.

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Authors and Affiliations

  1. Department of Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France

    Jean-Philippe Berthet MD, Charles-Henri Marty-Ané MD, Pascal Branchereau MD & Pierre Alric MD

  2. Department of Vascular Surgery, Doumergue Hospital, Nimes, France

    Eric Picard MD, Henri Mary MD & Reuben Veerapen MD

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  1. Jean-Philippe Berthet MD
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  2. Charles-Henri Marty-Ané MD
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  3. Eric Picard MD
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  4. Pascal Branchereau MD
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  5. Henri Mary MD
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  7. Pierre Alric MD
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Corresponding author

Correspondence to Jean-Philippe Berthet MD.

Appendix 1. Modified Rankin Scale

Appendix 1. Modified Rankin Scale

  1. 0.

    No symptoms at all

  2. 1.

    No significant disability despite symptoms; able to carry out all usual duties and activities

  3. 2.

    Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance

  4. 3.

    Moderate disability; requiring some help, but able to walk without assistance

  5. 4.

    Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance

  6. 5.

    Severe disability; bedridden, incontinent, and requiring constant nursing care and attention

  7. 6.

    Dead

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Berthet, JP., Marty-Ané, CH., Picard, E. et al. Acute Carotid Artery Thrombosis: Description of 12 Surgically Treated Cases. Ann Vasc Surg 19, 11–18 (2005). https://doi.org/10.1007/s10016-004-0074-x

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