Distal migration of a floating carotid thrombus in a patient using oral contraceptives: a case report

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Abstract

Introduction

We report the case of a patient with distal migration of a floating carotid thrombus caused by oral contraceptives.

Case presentation

A 48-year-old woman using oral contraceptives suffered from dysarthria and gait disturbance. Examinations, including ultrasound and cerebral arteriogram, revealed a floating thrombus at the left carotid bifurcation with no stenosis. Despite antithrombotic therapy, the floating carotid thrombus migrated to the ipsilateral middle cerebral artery, resulting in a severe stroke.

Conclusion

Some floating thrombi are resistant to conservative therapy and have a risk of distal migration, which may cause a major stroke in the acute stage.

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Most cited references 4

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Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices.

C Schönholz, G Garelli, J Parodi … (2000)

The purpose of the study was to assess the effectiveness of cerebral protection devices during carotid artery angioplasty and stent placement. Between September 1998 and September 1999, carotid angioplasty and stenting were performed in 46 patients with symptomatic (39.1%) or asymptomatic (60.9%) severe carotid artery stenosis. Wallstents were used in all patients with selective predilatation. Cerebral protection devices were used in 25 of these patients. Primary end points were perioperative neurologic complications and mortality. Data were collected prospectively. The overall combined end point of all neurologic deficits and death rate was 4.34%. Two neurologic events (one transient ischemic attack and one minor stroke) occurred in the unprotected group (9.53%) versus none in the group with cerebral protection. This difference is not statistically significant. The mortality rate was 0% for both groups. On an intention to treat basis, the overall technical success rate for carotid angioplasty was 97.8%, and for placement of cerebral protection devices it was 100%. An important number of particles of different sizes were captured in all cases in which cerebral protection devices were used. Experience has shown that cerebral protection during carotid angioplasty and stenting is technically feasible and appears to be effective in preventing procedure-related neurologic complications. Further investigation is warranted.

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Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.

(1996)

The risk of haemorrhagic stroke associated with use of oral contraceptives (OCs) is less well-established than that for ischaemic stroke. We assessed the risk of haemorrhagic stroke associated with current use of modern OCs as now used throughout the world. In this WHO collaborative, case-control study, we assessed the association between risk of haemorrhagic stroke and use of combined OCs in 1068 cases, aged 20-44 years, and 2910 age-matched controls. We also assessed risks for all strokes combined (haemorrhagic, ischaemic, and unclassified) based on 2198 cases and 6086 controls. Overall, current use of combined OCs was associated with slightly increased risk of haemorrhagic stroke; the increase was significant in the developing countries (odds ratio 1.76 [95% CI 1.34-2.30]) but not in Europe (1.38 [0.84-2.25]). Use of OCs in women younger than 35 years did not affect risk of haemorrhagic stroke in either group of countries, whereas in women aged older than 35 years, odds ratios were greater than 2. Women who were current users of OCs and had a history of hypertension (detected before current episode of OC use, but not during pregnancy) had a substantially increased risk (ten-fold to 15-fold) of haemorrhagic stroke compared with women who did not use OCs and had no history of hypertension. Odds ratios among current OC users who were also current cigarette smokers were greater than 3. In both groups of countries, past use of OCs, dose of oestrogen, and dose and type of progestagen had no effect on risk, and risks were similar for subarachnoid and intracerebral haemorrhage. The odds ratios for any type of stroke associated with current use of low-dose (< 50 micrograms oestrogen) and higher-dose OCs were 1.41 (0.90-2.20) and 2.71 (1.70-4.32), respectively, in Europe and 1.86 (1.49-2.33) and 1.92 (1.48-2.50) in the developing countries. From these data we estimated that about 13% and 8% of all strokes in women aged 20-44 in Europe and the developing countries, respectively, are attributable to the use of OCs. The risk of haemorrhagic stroke attributable to OC use is not increased in younger women and is only slightly increased in older women. The estimated excess risk of all stroke types associated with use of low-oestrogen and higher-oestrogen dose OCs in Europe was about two and eight, respectively, per 100 000 woman-years of OC use. However, findings need to be considered in the context of other risks and benefits associated with OC use, as well as those associated with the use of other forms of contraception.

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Clinical and angiographic features of carotid circulation thrombus.

Melissa Batson, Michael Ham, B. Abbott … (1986)

We studied five patients with intraluminal carotid thrombus visualized by angiography. The distinctive clinical features included the following: thrombus formation without significant atherostenosis; peripheral and cerebral arterial thrombosis; step-wise evolution of cerebral and/or peripheral signs over a period of days to several weeks; clotting tendency despite heparin anticoagulation; and carotid or iliac artery thrombosis after thrombo-endarterectomy. These unusual features serve to identify an uncommon subgroup of stroke patients with large artery thrombosis. Pathogenesis was not established. Coagulopathy with elevated factor VIII levels was the suspected mechanism.

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Author and article information

Journal

Journal ID (nlm-ta): J Med Case Reports

Title: Journal of Medical Case Reports

Publisher: BioMed Central

ISSN (Electronic): 1752-1947

Publication date Collection: 2009

Publication date (Electronic): 14 July 2009

Volume: 3

Page: 8389

Affiliations

[1 ]Department of Stroke Treatment, Shonan Kamakura General Hospital, 1202-1 Yamazaki, Kamakura, Kanagawa, Japan

[2 ]Department of Neurology, Graduate School of Medical Sciences, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, Japan

Article

Publisher ID: 1752-1947-0003-0000008389

DOI: 10.4076/1752-1947-3-8389

PMC ID: 2737801

PubMed ID: 19830227

SO-VID: 20443b2b-dc14-43a1-9bec-3eda2e6a4a2a

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Distal migration of a floating carotid thrombus in a patient using oral contraceptives: a case report

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Abstract

Introduction

Case presentation

Conclusion

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Most cited references 4

Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices.

Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.

Clinical and angiographic features of carotid circulation thrombus.

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