Ischemic stroke and floating thrombosis in dissection of the common carotid artery in patient at third week of pregnancy: Surgical technical success and maintenance of pregnancy

Thrombosis, especially in pregnancy, is due to a prothrombotic state and involves the venous system. Localization in an arterial segment is rare. Floating carotid arterial thrombosis is a very rare occurrence, but it is very devastating. The authors report the case of a pregnant patient in whom are...

Full description

Bibliographic Details
Main Authors: Andrea Ascoli Marchetti, Marina Diomedi, Silvia Ascoli Marchetti, Emilio Piccione, Arnaldo Ippoliti
Format: Article
Language:English
Published: SAGE Publishing 2019-02-01
Series:SAGE Open Medical Case Reports
Online Access:https://doi.org/10.1177/2050313X19831117
id doaj-dcf4b9268a614213bc210e365de58d71
record_format Article
spelling doaj-dcf4b9268a614213bc210e365de58d712020-11-25T03:24:45ZengSAGE PublishingSAGE Open Medical Case Reports2050-313X2019-02-01710.1177/2050313X19831117Ischemic stroke and floating thrombosis in dissection of the common carotid artery in patient at third week of pregnancy: Surgical technical success and maintenance of pregnancyAndrea Ascoli Marchetti0Marina Diomedi1Silvia Ascoli Marchetti2Emilio Piccione3Arnaldo Ippoliti4Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, ItalyStroke Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, ItalyFaculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, ItalyGynecology and Obstetrics Unit, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, ItalyVascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, ItalyThrombosis, especially in pregnancy, is due to a prothrombotic state and involves the venous system. Localization in an arterial segment is rare. Floating carotid arterial thrombosis is a very rare occurrence, but it is very devastating. The authors report the case of a pregnant patient in whom are associated a thrombotic predisposition and a traumatic event of the neck which resulted in a limited dissection and a floating thrombosis of the common carotid artery. The onset was characterized by sudden neurological deficits, including numbness of the right-hand fingers and right limb weakness, which regressed after admission. The patient underwent a surgical operation with success. Her pregnancy continued, and an ultrasound scan 12 months later confirmed the patency of the prosthesis, in the absence of neurological symptoms. Hormonal changes may reveal the condition of thrombophilia, which, however, occurs more frequently in the venous system and is a condition related to the free-floating thrombus. No guidelines exist for medical or surgical management. The endovascular approach appears to present a greater risk of embolization as an alternative to open surgery. This case demonstrates that the prothrombotic state and the presence of neurological symptoms are suggestive of arterial thrombosis in pregnancy and that the multidisciplinary approach is mandatory to achieve good results.https://doi.org/10.1177/2050313X19831117
collection DOAJ
language English
format Article
sources DOAJ
author Andrea Ascoli Marchetti
Marina Diomedi
Silvia Ascoli Marchetti
Emilio Piccione
Arnaldo Ippoliti
spellingShingle Andrea Ascoli Marchetti
Marina Diomedi
Silvia Ascoli Marchetti
Emilio Piccione
Arnaldo Ippoliti
Ischemic stroke and floating thrombosis in dissection of the common carotid artery in patient at third week of pregnancy: Surgical technical success and maintenance of pregnancy
SAGE Open Medical Case Reports
author_facet Andrea Ascoli Marchetti
Marina Diomedi
Silvia Ascoli Marchetti
Emilio Piccione
Arnaldo Ippoliti
author_sort Andrea Ascoli Marchetti
title Ischemic stroke and floating thrombosis in dissection of the common carotid artery in patient at third week of pregnancy: Surgical technical success and maintenance of pregnancy
title_short Ischemic stroke and floating thrombosis in dissection of the common carotid artery in patient at third week of pregnancy: Surgical technical success and maintenance of pregnancy
title_full Ischemic stroke and floating thrombosis in dissection of the common carotid artery in patient at third week of pregnancy: Surgical technical success and maintenance of pregnancy
title_fullStr Ischemic stroke and floating thrombosis in dissection of the common carotid artery in patient at third week of pregnancy: Surgical technical success and maintenance of pregnancy
title_full_unstemmed Ischemic stroke and floating thrombosis in dissection of the common carotid artery in patient at third week of pregnancy: Surgical technical success and maintenance of pregnancy
title_sort ischemic stroke and floating thrombosis in dissection of the common carotid artery in patient at third week of pregnancy: surgical technical success and maintenance of pregnancy
publisher SAGE Publishing
series SAGE Open Medical Case Reports
issn 2050-313X
publishDate 2019-02-01
description Thrombosis, especially in pregnancy, is due to a prothrombotic state and involves the venous system. Localization in an arterial segment is rare. Floating carotid arterial thrombosis is a very rare occurrence, but it is very devastating. The authors report the case of a pregnant patient in whom are associated a thrombotic predisposition and a traumatic event of the neck which resulted in a limited dissection and a floating thrombosis of the common carotid artery. The onset was characterized by sudden neurological deficits, including numbness of the right-hand fingers and right limb weakness, which regressed after admission. The patient underwent a surgical operation with success. Her pregnancy continued, and an ultrasound scan 12 months later confirmed the patency of the prosthesis, in the absence of neurological symptoms. Hormonal changes may reveal the condition of thrombophilia, which, however, occurs more frequently in the venous system and is a condition related to the free-floating thrombus. No guidelines exist for medical or surgical management. The endovascular approach appears to present a greater risk of embolization as an alternative to open surgery. This case demonstrates that the prothrombotic state and the presence of neurological symptoms are suggestive of arterial thrombosis in pregnancy and that the multidisciplinary approach is mandatory to achieve good results.
url https://doi.org/10.1177/2050313X19831117
work_keys_str_mv AT andreaascolimarchetti ischemicstrokeandfloatingthrombosisindissectionofthecommoncarotidarteryinpatientatthirdweekofpregnancysurgicaltechnicalsuccessandmaintenanceofpregnancy
AT marinadiomedi ischemicstrokeandfloatingthrombosisindissectionofthecommoncarotidarteryinpatientatthirdweekofpregnancysurgicaltechnicalsuccessandmaintenanceofpregnancy
AT silviaascolimarchetti ischemicstrokeandfloatingthrombosisindissectionofthecommoncarotidarteryinpatientatthirdweekofpregnancysurgicaltechnicalsuccessandmaintenanceofpregnancy
AT emiliopiccione ischemicstrokeandfloatingthrombosisindissectionofthecommoncarotidarteryinpatientatthirdweekofpregnancysurgicaltechnicalsuccessandmaintenanceofpregnancy
AT arnaldoippoliti ischemicstrokeandfloatingthrombosisindissectionofthecommoncarotidarteryinpatientatthirdweekofpregnancysurgicaltechnicalsuccessandmaintenanceofpregnancy
_version_ 1724600189134569472