Open AccessFree-floating and spinning thrombus of the basilar artery
Author(s) -
Keon-Yeup Kim,
SangHun Lee
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000025696
Subject(s) - medicine , thrombus , digital subtraction angiography , stenosis , basilar artery , radiology , magnetic resonance angiography , thrombosis , magnetic resonance imaging , cardiology , angiography
Rationale: Free-floating thrombi in the intracranial artery are rare. We report a case of a free-floating and spinning thrombus caused by turbulent flow distal to the basilar artery stenosis. We compare thrombus changes in a series of images according to time and describe the approach to treatment and thrombosis resolution. Patient concerns: A 55-year-old man presented to the emergency department on March 21, 2020, with left-sided weakness, bilateral limb ataxia, and a one-day history of dysarthria. Brain magnetic resonance imaging showed multifocal infarctions in the pons and cerebellum with severe basilar stenosis. Diagnoses: Digital subtraction angiography showed severe focal stenosis. A relatively large oval-shaped mobile thrombus was observed spinning due to turbulent flow at the distal portion of the stenosis. Interventions: We administered a combination antithrombotic regimen of warfarin and clopidogrel for 50 days. Outcomes: No thrombus was observed on the third follow-up digital subtraction angiography. Lessons: No previous study has directly observed a mobile thrombus in the intracranial artery using digital subtraction angiography. We used a combination antithrombotic strategy, which was effective after long-term, rather than short-term, use.