Carotid Artery Thrombus Research Articles

The natural flavonoid pinocembrin shows antithrombotic activity and suppresses septic thrombosis

Sepsis, an extreme host response to systemic infection, remains one of the leading causes of mortality worldwide. Platelets, which are integral to both thrombosis and inflammation, play a crucial role in the pathophysiology of sepsis. Excessive platelet activation and aggregation significantly increase the risk of thrombosis, thereby elevating mortality in septic patients. However, the etiology and treatment of this condition have not been comprehensively studied. This study identifies pinocembrin, a natural flavonoid compound derived from propolis, as a potential therapeutic agent for mitigating platelet activation and treating sepsis. In vivo, pinocembrin effectively inhibited FeCl3-induced carotid arterial occlusive thrombus formation and collagen/epinephrine-induced pulmonary thromboembolism in mouse models. In vitro, pinocembrin treatment suppressed multiple facets of platelet activation, including aggregation, secretion, and αIIbβ3-mediated signaling events. Mechanistically, pinocembrin repressed platelet functions by inhibiting Src/Syk/PLCγ2/MAPK signaling pathway. Using cecal ligation and puncture (CLP) mouse model to simulate human sepsis, pinocembrin reduced inflammatory cytokine release and septic thrombosis, thereby improving the survival rate of septic mice. Lipopolysaccharide (LPS)-induced model further substantiated these results. Overall, the inhibition of platelet activity by pinocembrin demonstrates significant therapeutic potential for managing life-threatening septic thrombosis.

Surgical thrombectomy for a huge free-floating thrombus in the internal carotid artery without atherosclerotic change

Surgical thrombectomy for a huge free-floating thrombus in the internal carotid artery without atherosclerotic change

Derivation of a clinical prediction score for the diagnosis of clinically significant symptomatic carotid artery disease.

Emergent vascular imaging identifies a subset of patients requiring immediate specialized care (i.e. carotid stenosis > 50%, dissection or free-floating thrombus). However, most TIA patients do not have these findings, so it is inefficient to image all TIA patients in crowded emergency departments (ED). Our objectives were to derive and internally validate a clinical prediction score for clinically significant carotid arterydisease in TIA patients. This was a planned secondary analysis of a prospective cohort study from 14 Canadian EDs. Among 11555 consecutive adult ED patients with TIA/minor stroke symptoms over 12 years, 9882 had vascular imaging and were included in the analysis. Our main outcome was clinically significant carotid artery disease, defined as extracranial internal carotid stenosis ≥ 50%, dissection, or thrombus in the internal carotid artery, with contralateral symptoms. Of 9882 patients, 888 (9.0%) had clinically significant carotid artery disease. Logistic regression was used to derive a 13-variable reduced model. We simplified the model into a score (Symcard [Symptomatic carotid artery disease] Score), with suggested cut-points for high, medium, and low-risk stratification. A substantial portion (38%) of patients were classified as low-risk, 33.8% as medium risk, and 28.2% as high risk. At the low-risk cut-point, sensitivity was 92.9%, specificity 41.1%, and diagnostic yield 1.7%. This simple score can predict carotid artery disease in TIA patients using readily available information. It identifies low-risk patients who can defer vascular imaging to an outpatient or specialty clinic setting. Medium-risk patients may undergo imaging immediately or with slight delay, depending on local resources. High-risk patients should undergo urgent vascular imaging.

Carotid Artery Dissection Caused by an Elongated Styloid Process: A Case Report

Eagle’s syndrome is caused by an elongated styloid process or calcified stylohyoid ligament that interferes with adjacent structures. Herein, we present the case of a 26-year-old man who presented to the emergency department due to sudden onset pain in the right occipital area, dysarthria, left hemiparesis, and left arm paresthesia. Computed tomography (CT) angiography revealed an intimal flap and thrombus in the proximal right internal carotid artery (ICA), indicative of carotid artery dissection, as well as direct contact between the styloid process and ICA on both sides. The patient underwent anticoagulation with intravenous heparin for 7 days, followed by 75 mg of clopidogrel per day. Following treatment, the patient gradually improved and was discharged with slight paresthesia in the left arm two weeks after symptom onset. Carotid artery dissection is a rare manifestation of Eagle’s syndrome caused by an elongated styloid process.

Contrast-enhanced ultrasound reveals free-floating thrombus in carotid artery: The cause of stroke is surprisingly plaque rupture.

Acute stroke poses a serious threat to people's health. The occurrence of a thrombus following the rupture of vulnerable plaques in the carotid artery is a significant contributor to the development of stroke. In previous case reports, it has been challenging to visualize tiny ulcerations within carotid artery plaques using computed tomography angiography (CTA) and digital subtraction angiography (DSA), even when the rupture of the plaque leads to the formation of a free-floating thrombus (FFT). However, in this particular case, contrast-enhanced ultrasound (CEUS) was able to overcome this limitation and provide a more precise assessment, confirming that the FFT formation was indeed a result of plaque rupture rather than any other potential causes. Cases that utilize CEUS to visualize the formation of ulcers and FFT resulting from plaque rupture are even more rare. As such, we present this case to shed light on this infrequent phenomenon. In this case study, we present a 65-year-old male patient who was admitted to the hospital due to headache and abnormal mental behavior for one day. During the routine cervical artery ultrasound examination upon admission, we detected the presence of plaque in the right internal carotid artery of the patient, resulting in luminal stenosis. Additionally, we observed suspected hypoechoic material at the distal end of the plaque. After undergoing CEUS examination, it was definitively determined that an ulcer had formed and a FFT had developed due to the rupture of carotid artery plaque. Subsequent CTA and DSA examinations further confirmed the presence of the FFT. The magnetic resonance imaging (MRI) reveals an acute lacunar infarction in the head of the right caput nuclei caudate, which strengthens the potential link between the patient's neurological and psychiatric symptoms observed during admission. The patient received prompt antiplatelet therapy and underwent cervical artery stenting surgery with the assistance of a distal embolic protection device. Following the procedure, the patient was discharged on the fourth day and experienced a complete recovery. CEUS is a valuable tool for visualizing FFT resulting from the rupture of vulnerable plaques in the carotid artery.

Stenting for subclavian steal phenomenon to restore cerebral perfusion due to acute carotid occlusion following carotid endarterectomy: a case report

BackgroundPerioperative symptomatic carotid artery occlusion after carotid endarterectomy is a rare complication. In this study, we present a case of symptomatic acute carotid artery occlusion that occurred after carotid endarterectomy in a patient with coexistent subclavian artery steal phenomenon, which was successfully treated with subclavian artery stenting.Case presentationA 57-year-old East Asian female presented with stenosis in the left common carotid artery and left subclavian artery along with subclavian steal. The proximal segment of the left anterior cerebral artery was hypoplastic, and the posterior communicating arteries on both sides were well-developed. Left internal carotid artery stenosis progressed during the follow-up examination; therefore, left carotid endarterectomy was performed. On the following day, symptoms of cerebral perfusion deficiency appeared due to occlusion of the left carotid artery. The stenotic origin of the left common carotid artery and the suspected massive thrombus in the left carotid artery posed challenges to carotid revascularization. Therefore, left subclavian artery stenting for the subclavian steal phenomenon was determined to be the best option for restoring cerebral blood flow to the whole brain. Her symptoms improved after the procedure, and the postprocedural workup revealed improved cerebral blood flow.ConclusionSubclavian artery stenting is safe and may be helpful in patients with cerebral perfusion deficiency caused by intractable acute carotid occlusion coexisting with the subclavian steal phenomenon. Revascularization of asymptomatic subclavian artery stenosis is generally not recommended. However, cerebral circulatory insufficiency as a comorbidity may be worth considering.

Sex-Dependent Occlusive Cardiovascular Disease Effects of Short-Term Thirdhand Smoke Exposure.

Thirdhand smoke (THS) is associated with many public health and disease concerns, such as respiratory illness, cancer, lipidemia, and cardiovascular disease (CVD). We have previously shown that a moderate to long-term exposure to THS increases the risk of thrombosis. However, whether short-term exposure to THS would produce any effects remains to be discovered. Therefore, this study investigated the impact of 1-month THS exposure on platelet function, in vivo and in vitro, and on cytokine response, in a sex-dependent manner. Secondhand smoke or clean air (CA) exposed upholstery materials for 1 week were kept in cages housed with 5-6 mice, and the procedure was repeated for 4 weeks. These THS-exposed mice were evaluated for thrombogenesis and platelet function assays. In addition, cytokines expression was evaluated from pooled serum. Compared to the CA group, THS exposure significantly shortened the tail bleeding time and carotid artery thrombus formation. Moreover, the female mice appeared more sensitive to THS exposure than males. Furthermore, platelet aggregation, dense granule secretion, and P-selectin activation markers were significantly elevated due to THS exposure. In addition, high-throughput screening showed at least 30 cytokines differentially modulated by THS in females relative to 26 in male mice. Collectively, these results demonstrate that 1 month of THS exposure represents a high health risk, in part, by triggering a prothrombotic phenotype that appears to be more significant in females, who are at a much higher risk for occlusive CVD. Additionally, changes in cytokine levels mediate some of the THS-induced occlusive effects. This study revealed that THS exposure for 1 month is detrimental to the cardiovascular health of both sexes; however, females could be more aggressively affected than males. In addition, interleukins and chemokines could be critical factors for initiating prothrombotic activity due to THS exposure.

Abstract 115: Carotid Intraluminal Thrombus Obscuring Underlying Carotid Web: Case Report

Introduction Carotid webs (CaW) have been increasingly recognized as a unique cause of recurrent ischemic strokes.1 They are defined as thin, intraluminal, shelf‐like lesions along the posterior aspect of the carotid bulb.1,2 Despite more awareness and ongoing studies into their pathogenesis, diagnosis, and management,3 they are still overlooked in clinical practice as a primary carotid ischemic etiology. Our case describes a patient with right extracranial internal carotid artery (ICA) thrombus secondary to later‐diagnosed CaW on close follow‐up imaging. Methods We report a 55‐year‐old African American man with history of hypertension, type 2 diabetes mellitus and hyperlipidemia presented with acute onset slurred speech and left facial droop (FP). His last known well was 24 hours prior to presentation, and NIHSS upon arrival was 3 (FP 2, dysarthria 1). CT angiography (CTA) of the head and neck demonstrated a nearly occlusive thrombus of the distal right M2 segment MCA as well as non‐hemodynamic stenosis of the proximal right ICA with possible underlying sidewall filling defect‐appearing lesion concerning for a posterior wall thrombus without underlying atherosclerosis at the bulb or otherwise. The patient was admitted to the neurovascular intensive care unit and started on aspirin and high‐risk heparin drip. His MRI Brain demonstrated multiple acute/subacute right MCA territory strokes, predominately in the right posterior insula, right frontal lobe, and right posterior corona radiata. His stroke workup was otherwise unrevealing, and he was discharged on apixaban 5mg BID. Results Close surveillance follow‐up imaging with CTA head and neck was planned and obtained one month later, which demonstrated resolution of the filling defect that was obscuring the currently visualized underlying right CaW pocket (Figure‐1). The prevalence of CaWs has been reported to be between 1.2% and 2.5% of patients with acute ischemic stroke. CaWs are most frequently seen in younger, female patients, and patients with these lesions are at increased risk of recurrent stroke.4,5 Determining the optimal management for these lesions remains essential, but the available data thus far have not been conclusive. Most patients are treated with antiplatelet therapy, but some elect to treat with anticoagulation due to the focal hemostasis caused by CaWs.6 However, multiple studies have suggested that medical management alone is likely not sufficient in reducing the recurrent stroke risk caused by CaWs.5,7 Neuro‐interventional procedures including carotid artery stenting have been reported as secondary prevention strategies in patients with recurrent strokes.5,7,8 Although data regarding the rate of recurrence of strokes secondary to these lesions remains unclear, the current data does suggest benefit and safety in pursuing carotid stenting to prevent recurrent strokes.5‐8 Conclusion In young patients with proximal ICA thrombosis without underlying atherosclerosis or other conventional stroke risk factors, CaW should be considered among other differentials including hypercoagulable status. Following acute medical management, short‐term surveillance imaging is essential to confirm or rule out the diagnosis. In our case, the patient’s proximal ICA thrombus resolved after short course of anticoagulation and was determined to be secondary to the obscured underlying CaW.

Importance of assessment of carotid plaques in the managementof acute ischemic stroke: floating intracarotid plaque

Mobile atheromatous plaques affecting large arteries are a major risk factor for embolic strokes. We report a case of extensive embolic cerebral infarction secondary to a vulnerable internal carotid artery plaque. A 67-year-old female was admitted with sudden left-sided weakness. A computed tomography brain scan revealed early ischemic changes in the right middle cerebral territory. The ultrasound Doppler showed soft mobile plaque with thrombus in the right internal carotid artery causing 90% stenosis. Magnetic resonance imaging brain scan performed later showed extensive right cerebral infarction. A computed tomography angiogram revealed ulcerated non-occlusive soft tissue plaque in the right internal carotid artery. She was also diagnosed with bladder cancer during this admission and was managed medically due to her performance status. Unstable vulnerable plaques can be symptomatic even in the absence of significant carotid stenosis. Hence, early identification of the plaque vulnerability, using new imaging modalities, and its medical stabilization can help to reduce the risk of cerebrovascular insults. The etiopathogenesis of inflammation within unstable vulnerable plaques and its concordance with inflammatory markers is still unclear. It is feasible in our case the malignantprocess could also be contributing to the inflammation within the blood vessels promoting vulnerability of the plaques.

A Free-Floating Internal Carotid Artery Thrombus and Acute Ischemic Stroke

Acute management of stroke with carotid free-floating thrombus (FFT) needs careful monitoring to proactively prevent the additional risk of infarction, and reducing intracranial bleeding is the primary goal. No management guidelines are available for this rare clinical condition. Here we presented a case study of a patient presenting with a carotid FFT with acute left-sided weakness. The patient was managed with anticoagulation alone, and the patient was discharged to return home in stable condition and good functional status with mild disability in the patient's left arm. In conclusion, carotid FFT is a rare clinical condition with underlying heterogeneous etiologies and individual-level bleeding risk stratification. Medical and surgical options are considered on a case-by-case basis.

VASCULAR COMPLICATIONS IN LYMPHOCYTIC THYROIDITIS – SONOGRAPHIC FINDINGS

Objective: Alert to the ultrasonographic findings of cervical vascular involvement in the context of lymphocytic thyroiditis, since it is a rare situation. Design and method: CASE DESCRIPTION: Male patient, 87 years old, caucasian, diagnosed with lymphocytic thyroiditis since 2004, euthyroid, stable until 2019, presenting an enlarged thyroid volume on that date. He has a history of ischemic stroke in 2003. In 2019, he underwent a thyroid ultrasound where the hypothesis of intraluminal thrombus of the right internal carotid artery was raised. The evaluation with cervical vascular ultrasonography revealed an iso-hypoechogenic, heterogeneous image, lining the arterial wall, in the proximal segment of the internal carotid arteries, without hemodynamic repercussions, compatible with a probable inflammatory/fibrous infiltrate, in the context of lymphocytic thyroiditis. Computed Tomography scan of the thyroid and soft tissue confirmed the progression of the adjacent soft tissue infiltrate. Results: DISCUSSION: Taking into account the size of the inflammatory changes and the fact that the patient remains euthyroid, it is important to question about a the possibility of an evolution/adjustment of the disease previously diagnosed in 2004 to a new one: Riedel's thyroiditis, also known as an invasive fibrous or sclerosing thyroiditis. Riedel's thyroiditis is a pathological condition with an unknown etiology that causes a fibro-inflammatory infiltrative stated in the 2019 examination. Considering the low prevalence of the pathology, it is important to alert sonographers to the possible vascular complications observed in a supposed Riedel's thyroiditis, in order to make a reliable evaluation and diagnosis of the cervical vascular ultrasonographic findings. Conclusions: Regarding the monitoring of lymphocytic thyroiditis, it is just as important to do a periodic evaluation of the dimensions, characteristics of the gland and analytical evaluation of the thyroid function, as it is to monitor the infiltrate of adjacent tissues, namely vascular, to prevent possible serious complications.

Physician Approaches to the Initial Management of an Intraluminal Thrombus in Recently Symptomatic Carotid Artery Stenosis: Results from the Hot Carotid Study (S20.005)

Physician Approaches to the Initial Management of an Intraluminal Thrombus in Recently Symptomatic Carotid Artery Stenosis: Results from the Hot Carotid Study (S20.005)

Acidente vascular cerebral isquêmico secundário a Carotid Web: Relato de Caso

Background: The carotid web is a rare type of myofibrous dysplasia which is receiving increased attention for being a risk factor of ischemic stroke. It is a rare carotid artery disease, and its incidence is about 0,62%. The carotid web presents as a membrane located inside the arterial lumen, protruding from the posterior wall of the carotid sinus or the starting portion of the internal carotid artery. In some cases, thrombus can be seen on the carotid web. This occurs due to blood stasis and platelet activation, resulting in thrombosis which can embolize intracranially. Case presentation: 40 years-old female presents with transient left paresthesia and paresis, lasting 60 minutes. Weeks after, she presented a stronger and transient event, associated with dysarthria and rhyme deviation. Magnetic resonance investigation showed ischemic stroke in the middle cerebral artery area and thrombus in the right internal carotid artery, and angiography evidenced the presence of a probable atherosclerotic plaque in the right carotid sinus, attached to a fresh thrombus. She started anticoagulation therapy. In control exam, the arterial area in the right carotid sinus was identified without the presence of thrombus, allowing a better characterization of a membrane attached to the posterior wall of the internal carotid artery, coming up with features compatible with carotid web. Due to the recurrence of neurological deficits, besides being transitory, it was opted for endovascular treatment, aiming to avoid the evolution of a transient neurological deficit to a permanent one. She was submitted to angioplasty and maintained on double antiagregation due to stent and, until the moment, did not present any new neurovascular events. Conclusion: The relevancy of this report is due to carotid web being an under-recognized cause of cryptogenic stroke that should always be suspected when there is recurrent infarction in the territory of one internal carotid artery.

Teaching NeuroImages: A fuzzy determination of stroke onset

A 73-year-old man with hypertension presented with left hemiparesis and left hemineglect of unclear duration. CT with angiography of the head and neck showed subacute infarcts of the right frontal lobe and a right internal carotid artery thrombus, with corresponding perfusion abnormalities that would have qualified him for thrombectomy (figure).1 On closer examination, his facial hair asymmetry suggested a matured hemineglect to his left face. Based on the unenhanced imaging findings and facial hair asymmetry, we estimated his stroke onset to be more than 24 hours prior to evaluation, thereby disqualifying him for thrombectomy.

To Determine Frequency of Carotid Stenosis in Patients with Recurrent Stroke

Objective: To determine frequency of carotid stenosis in patients with recurrent ischemic stroke by Doppler ultrasound Study design: Cross sectional study Place and Duration: This study is performed at Divisional Headquarter Teaching Hospital, Mirpur AJK from January 2021 to January 2022 Methodology: This study is conducted in sample size of 99 patients, with history of minor stroke or TIA within three month. Now presented with recurrent ischemic stroke .All patients with recurrent ischemic stroke advised carotid Doppler of extracranial carotid arteries. Carotid artery intima media thickness, thrombus, atheromatous plaques and percentage of carotid stenosis and peak systolic flow velocity of affected artery were also determined on Doppler Ultrasound. In addition, association between carotid stenosis and its risk factors such as Age,gender, Hypertension, diabetes ,smoking and dyslipidemia is also determined. Results: We found that 59% of study population with recurrent ischemic stroke have carotid stenosis and percentage of carotid stenosis is variable among study population. Out of 99 patients with recurrent stroke 52% population are Hypertensive, 46% have diabetic, and 58% are smoker and 51% have Dyslipidemia. Conclusion: We concluded that carotid artery stenosis is a risk factor for Recurrent ischemic stroke. It predisposes patients to further attacks of stroke in future .So Doppler Ultrasound must be advised to every patient with history of minor stroke/TIA. So that early intervention should be offered to patients to reduce risk of recurrent ischemic stroke . Keyword: Carotid stenosis, carotid Doppler or Duplex scan ,Stroke /TIA

Thrombus Migration Just before Surgery.

An 84-year-old woman was diagnosed with cardiogenic shock requiring emergent percutaneous coronary intervention. After emergency percutaneous coronary intervention, transthoracic echocardiography indicated a 30-mm mobile thrombus with the largest diameter of 35 mm in the left atrium (panel A). She was induced for urgent left atrial thrombectomy. Transesophageal echocardiography revealed that the left intra-atrial thrombus had migrated into the left ventricle passing through the aortic valve (panel B and Supplemental Digital Content video 1, https://links.lww.com/ALN/D62). Considering the size of the thrombus and the likelihood of entering carotid arteries, vascular echography was immediately performed and revealed a thrombus in the right common carotid artery. However, cerebral oximetry indicated that oxygen saturation decreased gradually from 77 to 62% in 30 min on the right side versus a constant reading of 40% on the left side. The atrial thrombectomy was abandoned, and an endovascular thrombectomy was performed instead, which confirmed the diagnosis. We believe that continuously monitoring the presence and/or migration of a large intracardiac thrombus is critical because the management of such a patient may be changed promptly. In addition, the reduction in cerebral oximetry reading was important for determining the laterality of the carotid-cerebral vasculature, but not reliable because it is dependent on the insufficiency of collateral flow.1 Therefore, the observed disappearance of an intracardiac large thrombus should be investigated in a timely matter to guide the management of the patient. Ultrasound can be used to quickly identify the possible location of the thrombus. This leads to reduction of time to intervention, which is significantly associated with improved outcomes.2The authors declare no competing interests.Video 1. Thrombus passing through the aortic valve, https://links.lww.com/ALN/D62

Carotid Artery Thrombus in Antiphospholipid Antibody Syndrome.

HomeRadiologyRecently Published PreviousNext Reviews and CommentaryFree AccessImages in RadiologyCarotid Artery Thrombus in Antiphospholipid Antibody SyndromeZongli Han, Hui Qi Zongli Han, Hui Qi Author AffiliationsFrom the Department of Neurosurgery, Peking University Shenzhen Hospital, 1120 Lianhua Rd, Shenzhen 518036, PR China.Address correspondence to H.Q. (email: [email protected]).Zongli HanHui Qi Published Online:Mar 14 2023https://doi.org/10.1148/radiol.221836MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 23-year-old previously healthy woman presented with sudden-onset right-sided hemiparesis and paresthesia. Brain MRI scan demonstrated acute left frontal lobe embolic infarcts. High-spatial-resolution vessel wall MRI scan revealed an isointense peripherally enhancing lesion in the left common carotid artery with resultant severe luminal narrowing, compatible with an intraluminal thrombus (Figure, A–C). Contrast-enhanced US image confirmed free-floating thrombus with proximal attachment to the vessel wall (Figure, D). Endarterectomy was performed, and an organized thrombus was confirmed with pathologic process. Antibody serology tests were positive for anticardiolipin immunoglobulin G, β-2 glycoprotein immunoglobulin G, and lupus anticoagulants. The diagnosis of antiphospholipid antibody syndrome was established according to the Miyakis criteria (1,2). The patient was treated with warfarin and showed no signs of clinical or radiologic relapse at 1-year follow-up.Images in a 23-year-old woman with sudden-onset right-sided hemiparesis and paresthesia. (A–C) T1-weighted three-dimensional isotropic variable flip-angle fast spin echo MRI scans with black-blood technique with a 3-T clinical scanner (uMR 780; United Imaging Healthcare) show vessel walls. (A) Axial and (B) coronal T1-weighted images without contrast material show an intraluminal T1 isointense lesion within the left common carotid artery with resultant severe luminal narrowing (arrows). (C) Coronal contrast-enhanced T1-weighted image shows peripheral linear contrast enhancement of the thrombus (arrow). (D) Contrast-enhanced US image demonstrates a free-floating thrombus with microbubbles between the thrombus and the carotid vessel (*) with proximal attachment to the vessel wall (arrowhead).Download as PowerPointOpen in Image Viewer Antiphospholipid antibody syndrome is an autoimmune disease characterized by recurrent arterial or venous thrombosis, pathologic pregnancy, and positive antiphospholipid antibodies (3). Neurologic manifestations, especially cerebral ischemia, are frequently present; however, presentation with carotid thrombus is uncommon (4).Disclosures of conflicts of interest: Z.H. No relevant relationships. H.Q. No relevant relationships.AcknowledgmentsThe authors thank Hui Zhang from the Department of Radiology, who helped with the interpretation of the high-resolution MRI. They also thank Liya Wei from the Department of Ultrasound, who helped with the interpretation of the contrast-enhanced US image.

Recurrent floating common carotid artery thrombus related to COVID-19: A case report

The occurrence of arterial and venous thrombosis during coronavirus infection has been widely reported since the beginning of the epidemic. Floating carotid thrombus (FCT) in the common carotid artery is exceptional and its main known cause is atherosclerosis. We describe the case of a 54-year-old man who developed, one week after the onset symptomatology of related to COVID-19 infection, an ischemic stroke, complicating a large intraluminal floating thrombus in the left common carotid artery. Despite surgery and anticoagulation, a local recurrence with other thrombotic complications occurred and the patient died.

Synthesis of Novel 3-Butylphthalide Derivatives Containing Isopentenylphenol Moiety as Potential Antiplatelet Agents for the Treatment of Ischemic Stroke.

In order to find novel antiplatelet drugs for the treatment of ischemic stroke, a series of 3-butylphthalide derivatives containing isopentenylphenol moiety were designed, synthesized and characterized with spectroscopic analyses. The in vitro antiplatelet activity results indicated that compound 3 better inhibited the arachidonic acid (AA) induced platelet aggregation than aspirin (ASP) and 3-butylphthalide (NBP). Additionally, compared with precursor NBP, compound 3 possessed outstanding antithrombotic activity in the animal experiment model, which could effectively alleviate the formation of tail thrombus and carotid artery thrombus in mice. More importantly, intraperitoneal administration of compound 3 can well protected the rats against ischemia/reperfusion-induced brain injury. Further pharmacokinetic (PK) assay indicated that compound 3 had good absorption characteristics and metabolic stability in vivo. Overall, the present research provides a new candidate compound for the treatment of ischemic stroke caused by platelet aggregation.

Etiologic and prognostic value of external carotid artery thrombus detection during endovascular therapy for anterior circulation proximal occlusions.

An early understanding of stroke mechanism may improve treatment and outcome in patients presenting with large vessel occlusion stroke (LVOS) treated with mechanical thrombectomy (MT). We aimed to investigate whether spontaneous external carotid artery (ECA) embolism detection during MT is associated with stroke etiology and clinical outcome. We retrospectively reviewed our prospectively maintained institutional database including consecutive patients with anterior circulation LVOS treated with MT between January 2015 and August 2020. An ECA embolus was detected in 68 of 1298 patients (5.2%). The kappa coefficient for interobserver agreement was 0.89 (95% confidence interval [CI] 0.82-0.95). ECA embolism was significantly associated with intracranial internal carotid artery (ICA) occlusion (p< 0.001), cardioembolic etiology (p< 0.001) and a lower clot burden score (p< 0.001). Day-1 variation of National Institutes of Health Stroke Scale score (adjusted odds ratio [OR] -2.7, 95% CI -4.9 to 0.3; p= 0.021) and delta Alberta Stroke Program Early Computed Tomography Score (adjusted OR 0.9, 95% CI 0.2 to 1.5; p= 0.004) were worse among patients with ECA emboli. There was no significant difference in 90-day functional outcome between groups (adjusted OR 0.8, 95% CI 0.42 to 1.52; p= 0.50). In patients with anterior circulation LVOS treated with MT, ECA embolism was significantly associated with cardioembolic etiology, high thrombus burden and proximal intracranial ICA occlusions. This underexplored angiographic pattern might provide a valuable etiologic clue to the underlying cause of anterior circulation LVOS and may also help determine the appropriate revascularization strategy.