Sami Al Kasab, MD
Singh R-J, Chakraborty D, Dey S, Ganesh A, Al Sultan AS, Eesa M, et al. Intraluminal Thrombi in the Cervico-Cephalic Arteries: Clinical-Imaging Manifestations, Treatment Strategies, and Outcome. Stroke. 2018;50:357–364.
With the increased imaging of the head and neck vasculature as part routine stroke/TIA workup, diagnosis of intraluminal thrombus (ILT) has become more common. The presence of ILT in the cervico-cephalic vasculature in patients with TIA or stroke poses a diagnostic and therapeutic challenge. In this study, Singh et al. report the clinical and imaging manifestation of ILT and provide recommendations on therapeutic options. The study was conducted at the University of Calgary. Patients with suspected TIA or stroke between April 2015 and September 2017 were included in these analyses. Diagnosis of ILT was made by CTA of the head and neck performed routinely on admission, which was evaluated by a neuroradiologist, once the diagnosis of ILT was made, it was confirmed by a second neuroradioloigst.
A total of 3750 patients were evaluated during the study period; ILT was identified in 61 patients (1.6%). Median age was 67 years (IQR, 56-73); 40 (65.6%) patients were men. Patients with ILT had high prevalence of hypertension, smoking and dyslipidemia (47.5%, 44.3%, and 41% respectively). The most common presentation was ischemic stroke (80.3%), and most strokes were mild with median NIHSS of 2 (IQR, 1-4). The most common location of ILT was extracranial internal carotid artery (65.6%), followed by extracranial vertebral artery (11.2%). The most common cause of ILT was atherosclerosis in the affected artery (82 %) manifested by ulcerated plaque with or without luminal stenosis. Ulcerated plaque was identified in 6.6% of patients only. 51/61 (83.6%) were found to have ≥50% underlying stenosis, arterial dissection was identified in 6.6% of cases and 1 patient (1.6%) had cardio-embolic etiology.