Free-floating thrombus in the right common carotid artery

Management of the symptomatic multiple stenosis of supra-aortic vessels (MSSVs) in a “bovine” aortic arch (BAA) configuration is infrequently reported. The optimal treatment choice remains debatable. A successful hybrid treatment for a proximal critical stenosis of the innominate and left common carotid artery was performed in a high-risk patient with a tandem symptomatic lesion in the right carotid bifurcation and a concentric vulnerable plaque in the bovine trunk. This case supports the feasibility, safety, and efficacy of a combined carotid bifurcation endarterectomy and retrograde kissing stenting of common carotid arteries with cerebral protection after evaluation of radiological, anatomical, and clinical parameters.

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Idiopathic Free-Floating Thrombus of the Common Carotid Artery

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100001815 ◽

2002 ◽

Vol 29 (1) ◽

pp. 97-99 ◽

Cited By ~ 6

Author(s):

Brian Silver ◽

Irene Gulka ◽

Michael Nicolle ◽

Ramesh Sahjpaul ◽

Vladimir Hachinski

Keyword(s):

Carotid Artery ◽

Common Carotid Artery ◽

Multimodal Imaging ◽

Doppler Ultrasonography ◽

Resonance Imaging ◽

Wall Defect ◽

Floating Thrombus ◽

Weighted Magnetic Resonance Imaging ◽

The Common ◽

One Year

Background:The observation of an intraluminal common carotid artery thrombus overlying a wall defect at ultrasonography or angiography is unusual. To our knowledge, there are no previous reports of a free-floating thrombus in the common carotid artery.Case Report:A 45-year-old woman who was previously healthy and on no medications presented with acute hemiparesis and aphasia. Following testing that included carotid duplex and trancranial Doppler ultrasonography, diffusion-weighted magnetic resonance imaging, and digital subtraction angiography, the patient underwent emergency open embolectomy. No underlying wall defect was seen at the time of imaging or surgery. No obvious hypercoagulable state could be identified. Her NIH Stroke Scale score improved from 26 at admission to 2 at three months and 1 at one year.Conclusions:Multimodal imaging may have improved diagnosis and management in this patient with a unique finding. The source of the thrombus remains obscure.

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Intrathoracic bifurcation of the right common carotid artery

BMJ Case Reports ◽

10.1136/bcr-2012-007554 ◽

2013 ◽

Vol 2013 (jan09 1) ◽

pp. bcr2012007554-bcr2012007554 ◽

Cited By ~ 6

Author(s):

C. K. Gomez ◽

O. J. Arnuk

Keyword(s):

Carotid Artery ◽

Common Carotid Artery ◽

The Right

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Eversion carotid endarterectomy with nerve-sparing component in a case of high location of common carotid artery bifurcation

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2021-3-94-99 ◽

2021 ◽

Vol 25 (3) ◽

pp. 94

Author(s):

I. V. Makarov ◽

A. S. Borisenkov ◽

I. A. Migunov

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Common Carotid Artery ◽

Preoperative Evaluation ◽

Cranial Nerves ◽

Hospital Medicine ◽

Nerve Sparing ◽

Left Internal Carotid Artery ◽

Brachiocephalic Trunk ◽

The Right

We performed carotid endarterectomy on a patient with 75% stenosis of the left internal carotid artery (ICA), 70% stenosis of the left common carotid artery (CCA), 60% stenosis of the right ICA and 55% stenosis of the right CCA after a transient ischaemic attack on the premises of the surgical unit of Russian Railways Hospital–Medicine (Samara), which is the clinical site for the care of surgical diseases at Samara State Medical University. During the preoperative evaluation and physical examination, we determined that the chance of high CCA bifurcation was high because the patient had a brachymorphic physique and his neck was short and broad. In fact, during the surgical exploration of the carotid triangle area, the CCA bifurcation was identified 7 ± 0.5 cm higher than the shield-like cartilage rim; thus the CCA bifurcation area crossed the stems of the glossopharyngeal (IX), vagus (X) and hypoglossal (XII) nerves, which precluded classic carotid endarterectomy. We then decided to perform carotid endarterectomy, using the eversion method and transposing the ICA above the rami of the cranial nerves. Through this method, we minimised traction and nerve stem trauma during the process of reconstructing brachiocephalic trunk arteries, prevented morbidities involving the cranial nerves during postsurgical period, accelerated the patient’s recovery and improved the patient’s quality of life. With further patient monitoring during the early and late postoperative periods, no abnormalities of peripheral innervation occurred.Received 26 March 2021. Revised 6 May 2021. Accepted 11 May 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflicts of interests.Contribution of the authors: The authors contributed equally to this article.

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An unusual origin of the right subclavian artery – arteria lusoria

Current Issues in Pharmacy and Medical Sciences ◽

10.1515/cipms-2015-0022 ◽

2014 ◽

Vol 27 (4) ◽

pp. 234-236

Author(s):

Agnieszka Mocarska ◽

Miroslaw Szylejko ◽

Elzbieta Staroslawska ◽

Franciszek Burdan

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Common Carotid Artery ◽

Left Vertebral Artery ◽

Anatomical Anomaly ◽

Arteria Lusoria ◽

Brachiocephalic Trunk ◽

The Right

Abstract The aortic arch usually gives off three major arterial branches: the brachiocephalic trunk, the left common carotid artery and the left subclavian artery. The most frequently occurring developmental variations of arterial trunks origins are a joined brachiocephalic and left common carotid artery origin, the left vertebral artery branching from the aortic arch, a double aortic arch, and a change of sequence of branching arteries. The current report presents the rare asymptomatic situation of the right subclavian artery originating as the last individual branching from the aortic arch. This abnormality was accidentally discovered in a computed tomography examination of a 69-year old male patient. The examination showed that the artery went towards the neck posteriorly from the trachea. The anatomical anomaly was interpreted as being an arteria lusoria.

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Clinical case of a patient with occlusive thrombosis of the right common carotid artery

Medical Journal of the Russian Federation ◽

10.17816/0869-2106-2021-27-1-79-86 ◽

2021 ◽

Vol 27 (1) ◽

pp. 79-86

Author(s):

Anna S. Zotova ◽

Tatyana V. Davydova ◽

Anna M. Snigireva

Keyword(s):

Carotid Artery ◽

Common Carotid Artery ◽

Asymptomatic Patient ◽

Duplex Ultrasound ◽

Carotid Bifurcation ◽

Ultrasound Scanning ◽

Severe Atherosclerosis ◽

The Common ◽

The Right ◽

Color Duplex Ultrasound

The paper presents a case of a patient with floating thrombosis in the right common carotid artery and occlusion of the carotid bifurcation of the right common carotid artery against the background of severe atherosclerosis of the common carotid artery with 70% stenosis. Thrombosis was identified using color duplex ultrasound scanning in an asymptomatic patient. During hospitalization, thrombosis was complicated by a cerebral infarction of the right middle cerebral artery, apparently of embolic origin.

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P186 CAROTID-GASTROPLASTY FISTULA: AN UNCOMMON CAUSE OF HEMATEMESIS IN THE DELAYED POSTOPERATIVE PERIOD AFTER ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doz092.186 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

L Hurtado-Pardo ◽

Navarro F Mingol ◽

Jiménez de Zadava Lissón M Menéndez ◽

Alonso C Pérez ◽

Esteban M Bruna ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Carotid Artery ◽

Cell Carcinoma ◽

Surgical Approach ◽

Postoperative Period ◽

Common Carotid Artery ◽

Muscle Flap ◽

Floor Of The Mouth ◽

Massive Hematemesis ◽

The Right

Abstract Aim To describe a case report of a carotid-gastroplasty fistula post esophagectomy with a successful result. Background & Methods Upper gastrointestinal bleeding due to a fistula between esophagus or gastroplasty and carotid vessels is infrequent. It is usually due to malignant tumors, penetrating trauma, foreign bodies or radiotherapy. Results A 55-year-old man, with background of laryngeal squamous cell carcinoma that was treated with total laryngectomy and tracheostomy followed by radiotherapy, and posterior recurrence of squamous cell carcinoma at the upper esophagus required total esophagectomy with pharynguectomy and lymphadenectomy, and reconstruction with gastroplasty with anastomosis to the floor of the mouth and pectoralis muscle flap. During this second postoperative period, patient developed a left hemiplegia secondary to thrombosis of the right common carotid artery. After recovery, the patient had repeated episodes of hematemesis that required hospital admission and blood transfusion. After several episodes with conservative management, upper endoscopy revealed blood oozing close to the anastomosis with no other findings. Once again, the patient returned to the emergency department with massive hematemesis, being visualized by endoscopy a high-flow arterial bleeding close to the anastomosis of the floor of the mouth. Arteriography showed the already known thrombosis of the right common carotid artery and the origin of the bleeding distal to that occlusion, where it was repermeabilized by a branch of the right vertebral artery. Given the inability of selective embolization by interventional radiology, urgent surgical approach was decided, performing a right lateral cervicotomy and identifying a fistula that communicated the common carotid artery with gastroplasty. It proceeded to close the fistulous orifice of the arteria and the gastroplasty with a continuous suture. A partial sternocleidomastoid muscle flap was interposed between the two sutures. The postoperative evolution was satisfactory. Patient was discharged 16 days after surgery and being currently stable without signs of hemorrhagic neither oncological recurrence. Conclusion Carotid-gastroplasty fistula is a rare complication with high mortality rate due to its more frequent presentation: the massive hematemesis. Gastrointestinal endoscopy and angiography allow us to diagnose and treat this complication, however in massive and uncontrollable bleeding, surgical approach is indicated. Prognosis will depend on the early diagnosis and a therapeutic individualization is required.

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Variations in the anatomical relationship between the common carotid artery and the internal jugular vein: An ultrasonographic study

Colombia Medica ◽

10.25100/cm.v46i2.1652 ◽

2015 ◽

pp. 54-59 ◽

Cited By ~ 3

Author(s):

Mauricio Umaña Perea ◽

Alberto Federico García ◽

José Luis Castillo García ◽

Luis Alfonso Bustamante Cristancho ◽

Juan Sebastián Martínez Collazos

Keyword(s):

Multivariate Analysis ◽

Carotid Artery ◽

Internal Jugular Vein ◽

Common Carotid Artery ◽

Jugular Vein ◽

Patients Âgés ◽

Anterior Position ◽

Anatomical Relationship ◽

The Common ◽

The Right

Introduction: The internal jugular vein locates anterior or anterolateral to the common carotid artery in two-thirds of the subjects studied by ultrasound when the head is in a rotated position. Aim: To identify variables associated with the anterior location of the internal jugular vein. Methods: Ultrasound examinations were performed with the patients in the supine position, with the head rotated to the opposite side. The proximal third of the neck was visualized transversely with a 7.5-mHz transducer. The relationship between the vessels was described in accordance with the proportion of the artery overlapped by the vein. Univariate comparisons and a multivariate analysis of potential variables that may affect the anatomic relationships were performed. Results: Seventy-eight patients were included, 44 of whom were men. The patients' ages ranged from 17 to 90 years (median 64.0, interquartile range 41-73). The right and left sides were studied 75 and 73 times, respectively. The vein was located lateral to the artery in 24.3% (95%CI= 17.4-32.2) of the studies, anterolateral in 33.8% (95%CI= 26.2-41.4) and anterior in 41.9% (95%CI= 33.9-49.8). The multivariate analysis identified age group (OR= 3.7, 95% CI 2.1-6.4) and, less significantly, the left side (OR= 1.7, 95%CI= 0.8-3.5) and male gender (OR= 1.2, 95%CI= 0.6-2.7) as variables associated with the anterior position of the vein. Conclusión: The anterior position of the internal jugular vein relative to the common carotid artery increases gradually with age. Additionally, left-sided localization and male sex further increased the probability of an anterior position.

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A Case of Congenital Absence of the Right Common Carotid Artery: A Rare Embryologic Anomaly

Journal for Vascular Ultrasound ◽

10.1177/154431670302700207 ◽

2003 ◽

Vol 27 (2) ◽

pp. 106-109 ◽

Cited By ~ 3

Author(s):

Donald Simons ◽

Peter Patetsios ◽

Robert Moglia ◽

Patrick Dietz

Keyword(s):

Carotid Artery ◽

Common Carotid Artery ◽

Congenital Absence ◽

The Right

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Endovascular treatment of asymptomatic free-floating thrombus in the carotid artery bifurcation: a direct aspiration first-pass technique under double balloon protection

BMJ Case Reports ◽

10.1136/bcr-2019-230295 ◽

2019 ◽

Vol 12 (8) ◽

pp. e230295 ◽

Cited By ~ 4

Author(s):

Ayumu Yamaoka ◽

Kei Miyata ◽

Satoshi Iihoshi ◽

Nobuhiro Mikuni

Keyword(s):

Carotid Artery ◽

Axillary Artery ◽

Anticoagulation Therapy ◽

Treatment Strategies ◽

Carotid Bifurcation ◽

Occlusion Balloon ◽

Floating Thrombus ◽

Balloon Catheters ◽

Ct Angiogram ◽

The Right

Free-floating thrombus (FFT) in the carotid artery has been reported as a rare cause of acute ischaemic stroke. There are various treatment strategies, but higher risk of distal embolism may limit their applicability. A 77-year-old woman noticed right upper arm weakness. A CT angiogram revealed that a large floating thrombus had strayed across the carotid bifurcation, while another thrombus was present in the right axillary artery. As for the carotid FFT, in spite of anticoagulation therapy, the number of asymptomatic microthrombuses gradually increased on diffusion-weighted MRI. We performed endovascular therapy utilising two temporary occlusion balloon catheters and performed direct aspiration with a reperfusion catheter. The procedure was uneventful. We successfully performed a new endovascular technique for FFT in the carotid bifurcation. Our method is effective, minimally invasive and safe.

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