Embolic Cerebral Infarction Caused by Intraluminal Thrombus in the Carotid Siphon Successfully Treated With Combination of Anticoagulant and Antiplatelet Drugs

A 54-year-old-man experienced serial ischemic embolic strokes and retinal artery embolism in the left carotid territory. In the acute phase, intraluminal thrombus in the left carotid siphon and frequent microembolic signals (MES) in the left middle cerebral artery were detected with magnetic resonance angiography (MRA) and transcranial Doppler (TCD). The patient was initially treated with only heparin for 3 days; however, more than 30 MES per 30 min were still detected. After adding ticlopidine as an antiplatelet therapy, MES were suppressed completely. After starting combination therapy of heparin (later warfarin) and ticlopidine, repeated MRA confirmed resolution of carotid thrombus and ischemic stroke did not recur. For management of intraluminal thrombus in the carotid artery, MES with TCD was useful in evaluating the risk of distal embolism. Combination treatment with anticoagulants and ticlopidine can both resolve the thrombus and prevent distal embolism.