颈动脉内游离血栓的诊断与外科治疗
Diagnosis and surgical management of free-floating thrombus within the carotid artery.
作者信息
Lane Tristan R A, Shalhoub Joseph, Perera Ryan, Mehta Amrish, Ellis Mary R, Sandison Ann, Davies Alun H, Franklin Ian J
机构信息
Department of Vascular Surgery, Charing Cross Hospital, Imperial College NHS Trust, Imperial College London, London, UK.
出版信息
Vasc Endovascular Surg. 2010 Oct;44(7):586-93. doi: 10.1177/1538574410375312. Epub 2010 Jul 30.
OBJECTIVE
Free-floating thrombus (FFT) of the carotid artery is a rare condition of currently unknown etiology. Less than 150 cases have been described in the published world literature to date.
DESIGN AND SETTING
We present 6 consecutive cases of carotid FFT, identified prospectively from 5000 carotid duplex scans over a 34-month period in a single tertiary center for vascular surgery.
RESULTS
All 6 cases involved the left carotid bifurcation in neurologically symptomatic individuals. In 5 of the 6 cases, FFT occurred in the absence of a significantly stenosing atheromatous plaque and was not associated with an elevation in velocity on duplex. The patients were all treated with surgical thromboendarterectomy, with good result.
CONCLUSIONS
Duplex imaging can underestimate the degree of stenosis. Free-floating thrombus presents a challenge in diagnosis due to its rapidly evolving nature. The management of FFT by acute thromboendarterectomy appears to be safe and effective in limiting further focal neurological sequelae.
目的
颈动脉漂浮血栓（FFT）是一种病因不明的罕见病症。迄今为止，全球已发表的文献中描述的病例不足150例。
设计与背景
我们报告了连续6例颈动脉FFT病例，这些病例是在一个单一的三级血管外科中心，在34个月的时间里，从5000次颈动脉双功超声扫描中前瞻性识别出来的。
结果
所有6例均累及有神经症状个体的左颈动脉分叉处。6例中有5例，FFT发生在无明显狭窄的动脉粥样硬化斑块的情况下，且与双功超声检查时的速度升高无关。所有患者均接受了外科血栓内膜切除术治疗，效果良好。
结论
双功超声成像可能会低估狭窄程度。由于其快速演变的性质，漂浮血栓在诊断方面具有挑战性。通过急性血栓内膜切除术治疗FFT似乎在限制进一步的局灶性神经后遗症方面是安全有效的。
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