背景:颈动脉自由漂浮血栓(CFT)是一种罕见的卒中原因,描述的是与动脉壁松散相关的腔内血栓,在血管成像上表现为完全被血流包围的充盈缺损。不幸的是,对于这种病理的理想治疗方法,专家之间没有明确的共识。
方法:回顾性分析2015年1月至2023年3月在计算机断层扫描血管造影(CTA)上诊断为CFT的急性缺血性卒中(AIS)和短暂性脑缺血发作(TIA)患者。我们旨在比较两种治疗方案:抗凝(ACT)和抗血小板(APT)治疗CFT。APT方案包括使用双抗血小板或单抗血小板(DAPT或SAPT;阿司匹林,氯吡格雷和替格瑞洛)和ACT方案包括使用直接口服抗凝药,华法林,肝素或低分子量肝素+/-ASA。接受机械血栓切除术的患者被排除在外。
结果:在研究期间,有8252例急性缺血性卒中住院,其中135例(1.63%)患者被诊断为CFT。66例患者纳入我们的分析。接受APT的患者年龄较大(60.41岁±12.82;p<0.01)。ACT和APT组的其他人口统计学变量相似。在30天时,重复血管成像的完整CFT分辨率在数值上较高(58.8vs31.6%,分别为;p=0.1)和最新随访(70.8vs50%;p=0.1),分别没有达到统计学意义。同样,与APT相比,ACT患者任何ICH的发生率在数值上较高,但没有达到统计学意义(27.6%vs13.5%;p=0.5).PH1/2出血性转化的发生率相似,ACT和APT组的出院独立性和相似的住院时间。与接受ACT治疗的患者相比,接受APT治疗的患者更有可能出院(86.5vs55.2%;p<0.001)。在30天的ACT和APT中,30天复发性卒中的发生率相当(分别为3.4对0%;p=0.1)。敏感性分析比较独占ACT与双APT导线的相似结果。
结论:我们的研究显示,在接受ACT和APT治疗的CFT患者中,疗效和安全性结果相当。需要更大的前瞻性研究。
BACKGROUND: Carotid free-floating thrombus (CFT) is a rare cause of stroke describing an intraluminal thrombus that is loosely associated with the arterial wall and manifesting as a filling defect fully surrounded by flow on vascular imaging. Unfortunately, there is no clear consensus among experts on the ideal treatment for this pathology.
METHODS: Retrospective analysis of acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients diagnosed with CFT on computed tomography angiogram (CTA) between January 2015-March 2023. We aimed to compare two treatment regimens: anticoagulation (ACT) and antiplatelet (APT) in the treatment of CFT. APT regimens included the use of dual or single antiplatelets (DAPT or SAPT; aspirin, clopidogrel and ticagrelor) and ACT regimens included the use of direct oral anticoagulants, warfarin, heparin or low molecular weight heparin +/- ASA. Patients that underwent mechanical thrombectomy were excluded.
RESULTS: During study time there were 8252 acute ischemic stroke hospitalizations, of which 135 (1.63 %) patients were diagnosed with CFT. Sixty-six patients were included in our analysis. Patients assigned to APT were older (60.41years ± 12.82;p < 0.01). Other demographic variables were similar between ACT and APT groups. Complete CFT resolution on repeat vascular imaging was numerically higher at 30 days (58.8 vs 31.6 %, respectively; p = 0.1) and at latest follow-up (70.8 vs 50 %; p = 0.1) on ACT vs APT, respectively without reaching statistical significance. Similarly, there was numerically higher rates of any ICH with ACT compared to APT but it did not achieve statistical significance (27.6 % vs 13.5 %; p = 0.5). There were similar rates of PH1/2 hemorrhagic transformation, independence at discharge and similar hospital length of stay between ACT and APT groups. Patients assigned to APT were more likely to be discharged on their assigned treatment compared to those assigned to ACT (86.5 vs 55.2 %; p < 0.001). The rate of 30-day recurrent stroke was comparable among ACT and APT at 30 days (3.4 vs 0 %; p = 0.1, respectively). Subgroup analysis comparing exclusive ACT vs Dual APT lead to similar results.
CONCLUSIONS: Our study showed comparable efficacy and safety outcomes in CFT patients who were exclusively managed medically with ACT vs APT. Larger prospective studies are needed.