Minimal literature exists regarding subocclusive thrombi and their management in acute
ischemic stroke, and no randomized trials or guidelines are currently available. We
present the case of an 83-year-old man with multiple vascular risk factors and recent
cardiac surgery who presented with a severe left middle cerebral artery (MCA) syndrome
due to a subocclusive thrombus. Intravenous (IV) tissue plasminogen activator was
contraindicated given the patient's recent surgery, and endovascular therapy was deferred
given improvement in symptoms. He was placed on IV heparin. His symptoms improved
with recanalization of the MCA. Optimal management of subocclusive thrombi, which
appear to have better outcomes than occlusive thrombi, has yet to be elucidated. Acute
anticoagulation and endovascular therapy may both be reasonable; however, there are
minimal data supporting the use of either and further studies are needed to develop
the most favorable treatment algorithm. In the meantime, management decisions should
be made on a case-by-case basis by multidisciplinary care teams.
Key Words
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Article info
Publication history
Published online: December 24, 2015
Accepted:
November 22,
2015
Received in revised form:
November 7,
2015
Received:
September 16,
2015
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.11.024
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
