Dados do Trabalho

Título

Complete resolution of a huge carotid thrombus after anticoagulation in 48-year-old woman with stroke

RESUMO

CASE PRESENTATION A 48-year-old woman, without previous comorbidities, admitted by complete right hemiparesis, mixed transcortical aphasia and right homonymous hemianopsia 7 hours after admission, NIHS 7. Imaging of the skull at the arrival showed no established ischemic lesion, however, arterial angiography of the neck showed the presence of a subtraction image inside the left common carotid artery with irregular contours reducing the lumen of the vessel by up to 90%, suggesting the presence of intra-arterial thrombus. Started full anticoagulation with soredic enoxapara at a total dose of 120mg/d. He presented a transesophageal echocardiography (ETE) demonstrating patent foramen of high conductance. Maintained anticoagulation with Apixaban at hospital discharge at a total dose of 10mg and after 15 days of treatment, a new control image was performed now with vessel wall protocol with evidence of complete resolution of the thrombus and absence of dissection of the vessel wall.

DISCUSSION: common carotid artery occlusion (AOCC) is a rare disease and accounts for 1%–5% of all cerebrovascular events. May present as stroke, transient ischemic attack (ITA), or with features of cerebral hypoperfusion. Chronic arterial occlusions are often attributed to atherosclerosis, while other less frequent causes include cardiac embolism, Takayasu's arteritis, post-radiation arteriopathy, syphilis, trauma. To date, there is no clear consensus on the best treatment in the face of a AOCC and the decisions for treatment of these patients are made according to each case and experience of the service.

OUTCOMES: occlusion of the common carotid artery although rare and acute clinical presentations vary from mild to devastating, the acute management of these patients remains a major challenge. In our service we report the case of a young patient with probable cardioembolic etiology who obtained benefit in the resolution of the thrombus with the use of direct oral anticoagulants.

Palavras Chave

stroke; common carotid artery occlusion