Adherent internal carotid artery (ICA) thrombi constitute a rare entity in patients with stroke. Management, whether surgical (thrombectomy) or conservative (anticoagulation), still relies on the experience and personal beliefs of the treating physician. We describe 2 patients who were treated with intravenous heparin sodium. In these patients, serial carotid ultrasound examination findings demonstrated changes in the consistency of the thrombi and, in particular, demonstrated the appearance of a hyperintense rim surrounding the thrombi a few days after the introduction of anticoagulation therapy. After the appearance of this rim, thrombi were completely dissolved within the following 3 to 5 days.
Karapanayiotides T, Piechowski-Jozwiak B, Michel P, Bogousslavsky J, Devuyst G. "Hyperechogenic Rim" Sign in Internal Carotid Artery Thrombus. Arch Neurol. 2004;61(5):773-774. doi:10.1001/archneur.61.5.773