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Symptomatic carotid artery intraluminal thrombus: risk of medical management failure and distal embolization.

Publication ,  Journal Article
Schartz, D; Susa, S; Ellens, N; Akkipeddi, SMK; Houk, C; Bhalla, T; Mattingly, T; Hasan, D; Bender, MT
Published in: J Neurointerv Surg
December 26, 2024

BACKGROUND: Carotid artery intraluminal thrombus (ILT), or free-floating thrombus, is an uncommon cerebrovascular entity with considerable equipoise regarding its clinical management. Likewise, in patients treated with medical management (MM), distal embolization and/or intracranial hemorrhage (ICH) may still occur. METHODS: All patients with symptomatic ILT from 2016 to 2023 were identified from our tertiary care institution. Patients with MM failure (recurrent cerebral ischemia and/or symptomatic ICH) were compared with patients with MM non-failure. Differences in ILT volume and length were calculated. Receiver operator characteristic (ROC) curve analysis was used to identify the cut-off volume and length for risk of MM failure. RESULTS: In total, 45 patients with ILT were identified with 41 treated with frontline MM. Of these 41 patients treated with MM, seven (17%) had MM failure with six (14.6%) having new embolic stroke and one (2.3%) with symptomatic ICH. Patients with MM failure had a significantly higher mean thrombus volume than MM non-failure patients (257 mm3 vs 59.6 mm3, P=0.0006). Likewise, patients with MM failure had significantly longer thrombus on average (21 mm vs 6.6 mm, P=0.0009). ROC curve analysis showed that an ILT volume of 90 mm3 resulted in a sensitivity of 71.4% and specificity of 85.3% for MM failure (AUC 0.775; CI 0.55 to 1.0, P=0.023). CONCLUSIONS: Carotid ILTs that fail MM are significantly larger and longer. These findings suggest that a thrombus volume of 90 mm3 may serve as a guide for intervention with good sensitivity and specificity for risk of MM failure.

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Published In

J Neurointerv Surg

DOI

EISSN

1759-8486

Publication Date

December 26, 2024

Volume

17

Issue

e1

Start / End Page

e55 / e59

Location

England

Related Subject Headings

  • Treatment Failure
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Female
  • Carotid Artery Thrombosis
  • Aged, 80 and over
  • Aged
  • 3209 Neurosciences
 

Citation

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Schartz, D., Susa, S., Ellens, N., Akkipeddi, S. M. K., Houk, C., Bhalla, T., … Bender, M. T. (2024). Symptomatic carotid artery intraluminal thrombus: risk of medical management failure and distal embolization. J Neurointerv Surg, 17(e1), e55–e59. https://doi.org/10.1136/jnis-2023-021044
Schartz, Derrek, Stephen Susa, Nathaniel Ellens, Sajal Medha K. Akkipeddi, Clifton Houk, Tarun Bhalla, Thomas Mattingly, David Hasan, and Matthew T. Bender. “Symptomatic carotid artery intraluminal thrombus: risk of medical management failure and distal embolization.J Neurointerv Surg 17, no. e1 (December 26, 2024): e55–59. https://doi.org/10.1136/jnis-2023-021044.
Schartz D, Susa S, Ellens N, Akkipeddi SMK, Houk C, Bhalla T, et al. Symptomatic carotid artery intraluminal thrombus: risk of medical management failure and distal embolization. J Neurointerv Surg. 2024 Dec 26;17(e1):e55–9.
Schartz, Derrek, et al. “Symptomatic carotid artery intraluminal thrombus: risk of medical management failure and distal embolization.J Neurointerv Surg, vol. 17, no. e1, Dec. 2024, pp. e55–59. Pubmed, doi:10.1136/jnis-2023-021044.
Schartz D, Susa S, Ellens N, Akkipeddi SMK, Houk C, Bhalla T, Mattingly T, Hasan D, Bender MT. Symptomatic carotid artery intraluminal thrombus: risk of medical management failure and distal embolization. J Neurointerv Surg. 2024 Dec 26;17(e1):e55–e59.

Published In

J Neurointerv Surg

DOI

EISSN

1759-8486

Publication Date

December 26, 2024

Volume

17

Issue

e1

Start / End Page

e55 / e59

Location

England

Related Subject Headings

  • Treatment Failure
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Female
  • Carotid Artery Thrombosis
  • Aged, 80 and over
  • Aged
  • 3209 Neurosciences