O-046 - POST-OPERATIVE COMPLICATIONS AFTER CAROTID ENDARTERECTOMY FOR FREE-FLOATING THROMBUS

TOPIC:
Other
AUTHORS:
Butt A. (Division of Vascular Surgery, University of British Columbia ~ Vancouver ~ Canada) , Al-Adawi S. (Division of Vascular Surgery, University of British Columbia ~ Vancouver ~ Canada) , Udawadia F. (Faculty of Medicine, University of British Columbia ~ Vancouver ~ Canada) , Taylor D. (Division of Vascular Surgery, University of British Columbia ~ Vancouver ~ Canada) , Chen J. (Division of Vascular Surgery, University of British Columbia ~ Vancouver ~ Canada) , Misskey J. (Division of Vascular Surgery, University of British Columbia ~ Vancouver ~ Canada)
Introduction:
The standard of care for patients with symptomatic, severe carotid artery stenosis includes carotid endarterectomy (CEA) plus best medical therapy. A rare cause of this etiology is acute thrombus within the internal carotid artery, referred to as Free-Floating Thrombus (FFT). This pathology is reported to have unstable plaque characteristics and an incidence rate of 0.4-1.5%. Given its rarity there remains a significant gap in understanding of the management of this condition.
Methods:
A retrospective review of patients in a prospectively collected database was conducted on all patients who underwent CEA for symptomatic carotid artery stenosis at a single institution between 2010 and 2020. Patients were identified after radiographic review of CT angiography at the time of diagnosis as having a FFT. Primary outcomes such as delay to procedure, stroke rates, and other complications, as well as rates of hospital transfers, were measured and compared between groups.
Results:
During the study period, 802 CEA were performed, of which, 45 patients were identified to have FFT. Patients in the FFT cohort had a shorter time interval from the date of consult to date of procedure (5.2 vs. 10.8 days). Furthermore, this patient group experienced higher rates of major complications such as stroke (4.4% vs. 1.6%), but not for other complications, such as hematoma formation or cranial nerve injury (8.8% vs. 10.1%). The FFT cohort also had higher rates of hospital transfer (17.7% vs. 4.2%). 13/45 (29%) had complete resolution of the FFT with preoperative heparinization and an additional 9 (20%) demonstrated significant reduction in thrombus size.
Conclusion:
Symptomatic carotid artery stenosis with FFT is a very high-risk phenotype of symptomatic carotid stenosis associated with a threefold higher rate of postoperative stroke. Heparinization was associated with a significant reduction in the size of the FFT and facilitated operative intervention without a documented increased in risk of preoperative neurological events.