1 Department of Clinical Neurological Sciences, Division of Neurology, University of Western Ontario, London, Canada.
2 Department of Clinical Neurological Sciences, Division of Neurosurgery, University of Western Ontario, London, Canada.
Int J Stroke. 2019 Apr;14(3):247-256. doi: 10.1177/1747493019828554. Epub 2019 Feb 6.
There is no consensus regarding the management of carotid free-floating thrombi in patients with acute ischemic stroke and transient ischemic attack.
This systematic review aims to (1) describe the current imaging methods for diagnosis of carotid free-floating thrombi and its associated risk factors, (2) estimate the proportion of carotid free-floating thrombi diagnosed in stroke patients, (3) estimate the proportion of carotid free-floating thrombi patients treated medically and surgically, and (4) evaluate 30-day outcomes.
We searched MEDLINE, EMBASE, and manually for references reporting carotid free-floating thrombi from 1960 until June 2017. We estimated the frequency of carotid free-floating thrombi and evaluated 30-day outcomes using Cox regression. We defined the timing of surgical intervention as early (less than 72 h) and delayed (more or equal to 72 h).
We retrieved 525 carotid free-floating thrombi cases from 58 case series and 83 case reports. Carotid free-floating thrombi were present in 1.53% of stroke patients. Carotid free-floating thrombi diagnosis was made by digital subtraction angiography (38.1%), carotid duplex ultrasound (29.5%), and computed tomography angiography (29.5%). The 30-day risk of transient ischemic attack, silent brain ischemia, any stroke or death was 17.1%. In multivariate analyses, there were no differences in outcome for any anticoagulation regime or timing of revascularization procedure.
The diagnosis of carotid free-floating thrombi is more common due to the increased use of early noninvasive vascular imaging in transient ischemic attack and stroke. It poses a high short-term risk of stroke and death, but there is as yet no established treatment. The low quality of evidence in the carotid free-floating thrombi literature limits the interpretation of our results and warrants a large-scale prospective cohort study in carotid free-floating thrombi.
急性缺血性卒中和短暂性脑缺血发作患者的颈动脉游离血栓的处理方法尚未达成共识。
本系统评价旨在：（1）描述诊断颈动脉游离血栓及其相关危险因素的当前影像学方法；（2）估计诊断为颈动脉游离血栓的卒中患者的比例；（3）估计接受药物和手术治疗的颈动脉游离血栓患者的比例；（4）评估 30 天结局。
我们检索了 MEDLINE、EMBASE，并手工检索了自 1960 年至 2017 年 6 月期间有关颈动脉游离血栓的参考文献。我们使用 Cox 回归估计颈动脉游离血栓的频率和评估 30 天结局。我们将手术干预时机定义为早期（<72 小时）和延迟（≥72 小时）。
我们从 58 个病例系列和 83 个病例报告中检索到 525 例颈动脉游离血栓病例。颈动脉游离血栓在 1.53%的卒中患者中存在。颈动脉游离血栓的诊断方法为数字减影血管造影（38.1%）、颈动脉双功能超声（29.5%）和计算机断层血管造影（29.5%）。30 天内出现短暂性脑缺血发作、无症状性脑缺血、任何卒中和死亡的风险为 17.1%。在多变量分析中，任何抗凝方案或血管再通术时机的结果均无差异。
由于在短暂性脑缺血发作和卒中患者中早期非侵入性血管成像的应用增加，颈动脉游离血栓的诊断更为常见。它在短期内发生卒中与死亡的风险较高，但目前尚无既定的治疗方法。颈动脉游离血栓文献中的证据质量较低限制了我们结果的解释，需要在颈动脉游离血栓患者中进行大规模的前瞻性队列研究。
