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Images in Neurology
December 2016

Treatment of Carotid Intramural Thrombus With TPA

Author Affiliations
  • 1Department of Neurology, University of Utah, Salt Lake City
JAMA Neurol. 2016;73(12):1496. doi:10.1001/jamaneurol.2016.3223

A man in his 50s developed left facial droop, dysarthria, and neglect. He presented to the emergency department, where he was found to have a National Institutes of Health Stroke Scale score of 13. He was treated with intravenous tissue plasminogen activator 60 minutes after stroke onset. A computed tomographic angiogram (CTA) was performed, which showed a right internal carotid artery intramural thrombus in the carotid bulb. Fourteen hours later, a second CTA showed resolution of the thrombus, and magnetic resonance imaging showed multifocal vessel-vessel thromboembolic right middle cerebral artery ischemic stroke (Figure). Reports have shown resolution of mural thrombi after thrombolysis,1,2 but recurrent stroke rates are high regardless of treatment.2

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