warfarin and Carotid-Artery-Diseases

Topics: Arterial Occlusive Diseases; Aspirin; Carotid Artery Diseases; Cerebrovascular Disorders; Dipyridamole; Endarterectomy; Female; Heparin; Humans; Ischemic Attack, Transient; Male; Risk; Warfarin

Atrial fibrillation (AF) increases risk of stroke 5-fold. Carotid artery disease (CD) also augments the risk of stroke, yet there are limited data about the interplay of these 2 diseases and clinical outcomes in patients with comorbid AF and CD.. Among patients with both AF and CD, use of rivaroxaban when compared with warfarin is associated with a lower risk of stroke.. This post hoc analysis from ROCKET AF aimed to determine absolute rates of stroke/systemic embolism (SE) and bleeding, and the efficacy and safety of rivaroxaban compared with warfarin in patients with AF and CD (defined as history of carotid occlusive disease or carotid revascularization [endarterectomy and/or stenting]).. A total of 593 (4.2%) patients had CD at enrollment. Patients with and without CD had similar rates of stroke or SE (adjusted hazard ratio [HR]: 0.99, 95% confidence interval [CI]: 0.66-1.48, P = 0.96), and there was no difference in major or nonmajor clinically relevant bleeding (adjusted HR: 1.04, 95% CI: 0.88-1.24, P = 0.62). The efficacy of rivaroxaban compared with warfarin for the prevention of stroke/SE was not statistically significant in patients with vs those without CD (interaction P = 0.25). The safety of rivaroxaban vs warfarin for major or nonmajor clinically relevant bleeding was similar in patients with and without CD (interaction P = 0.64).. Patients with CD in ROCKET AF had similar risk of stroke/SE compared with patients without CD. Additionally, there was no interaction between CD and the treatment effect of rivaroxaban or warfarin for stroke prevention or safety endpoints.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Carotid Artery Diseases; Dose-Response Relationship, Drug; Double-Blind Method; Embolism; Factor Xa Inhibitors; Female; Follow-Up Studies; Humans; Male; Risk Factors; Rivaroxaban; Stroke; Treatment Outcome; Warfarin

Few clinical trials have documented the efficacy of preventive treatment in asymptomatic women.. Lovastatin and minidose warfarin were evaluated in a factorially designed, placebo-controlled, randomized trial. The primary outcome was 3-year change in the mean maximum intimal-medial thickness of the carotid arteries as measured by B-mode ultrasonography. Participants (n=919) were randomized to 1 of 4 treatment groups: lovastatin alone, warfarin alone, lovastatin+warfarin combination, or a double-placebo group. Eligible participants were asymptomatic for cardiovascular disease, with evidence of early carotid atherosclerosis and moderately elevated LDL cholesterol level. Almost half (n=445) of the participants were women. To avoid confounding, 117 women taking estrogen were excluded from analysis. Both sexes experienced reductions in disease progression with lovastatin; there was no evidence of an overall sex x treatment interaction (P=0.72). When estimates of the sex-specific results were examined post hoc, women experienced disease regression to the greatest extent with the lovastatin + warfarin combination (P=0.02), although the women on lovastatin alone also had a reduction in progression (P=0.09). Men experienced the greatest reduction with lovastatin alone (P=0.02), although there is a suggestion that warfarin may also reduce progression to some extent.. Lovastatin is beneficial in reducing disease progression in women and men. Warfarin has no effect in women, although it may reduce progression in men. In men, warfarin does not add to the benefit of lovastatin and has no advantage over lovastatin alone.

Topics: Adult; Aged; Arteriosclerosis; Carotid Artery Diseases; Carotid Artery, Common; Carotid Artery, Internal; Cholesterol, LDL; Disease Progression; Double-Blind Method; Factor Analysis, Statistical; Female; Follow-Up Studies; Humans; Lovastatin; Male; Middle Aged; Sex Characteristics; Ultrasonography; Warfarin

The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors have proven to be more effective in reducing levels of low density lipoprotein (LDL) cholesterol and to be better tolerated than other lipid-lowering compounds. Most of the trials evaluating the effects of these new agents on progression of atherosclerosis have not included individuals asymptomatic for cardiovascular disease and who have LDL cholesterol levels at or below the limits established by the National Cholesterol Education Program for initiating treatment. The Asymptomatic Carotid Artery Progression Study (ACAPS) tested the effect of the HMG-CoA reductase inhibitor, lovastatin, on early-stage carotid atherosclerosis (as detected by B-mode ultrasonography) in 919 asymptomatic men and women, 40-79 years of age, who had LDL cholesterol levels between the 60th and 90th percentiles. Participants randomized into this double-blind, placebo-controlled, factorially designed study received lovastatin (20-40 mg/day) or lovastatin-placebo and warfarin (1 mg/day), or warfarin-placebo over a 3-year period. The progression of the mean maximum intimal-medial thickness (IMT) over 12 walls of both carotid arteries represented the primary outcome. Lovastatin treatment was associated with a reduction in progression of mean maximum IMT (p < 0.001). Levels of LDL cholesterol were reduced by 28% (43.5 mg/dl [11.25 mmol/liter]) in the lovastatin group within 6 months (p < 0.0001) and remained stable throughout the follow-up period, whereas these levels remained essentially unchanged in the lovastatin-placebo group. The difference in incidence of major cardiovascular events for patients in the lovastatin-placebo group was significant: 5 versus 14, respectively (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Anticholesteremic Agents; Anticoagulants; Arteriosclerosis; Carotid Arteries; Carotid Artery Diseases; Cholesterol, LDL; Double-Blind Method; Enzyme Inhibitors; Female; Follow-Up Studies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Lovastatin; Male; Middle Aged; Multivariate Analysis; Regression Analysis; Treatment Outcome; Ultrasonography; Warfarin

HMG CoA reductase inhibitors (or statins), a new class of lipid-lowering compounds, have raised expectations for more widespread use than that of the older lipid-lowering drugs. Not only are they more effective in lowering LDL cholesterol, but they are better tolerated as well. No data exist concerning the effect of statins on early carotid atherosclerosis and clinical events in men and women who have moderately elevated LDL cholesterol levels but are free of symptomatic cardiovascular disease.. Lovastatin (20 to 40 mg/d) or its placebo was evaluated in a double-blind, randomized clinical trial with factorial design along with warfarin (1 mg/d) or its placebo. This report is limited to the lovastatin component of the trial. Daily aspirin (81 mg/d) was recommended for everyone. Enrollment included 919 asymptomatic men and women, 40 to 79 years old, with early carotid atherosclerosis as defined by B-mode ultrasonography and LDL cholesterol between the 60th and 90th percentiles. The 3-year change in mean maximum intimal-medial thickness (IMT) in 12 walls of the carotid arteries was the primary outcome; change in single maximum IMT and incidence of major cardiovascular events were secondary outcomes. LDL cholesterol fell 28%, from 156.6 mg/dL at baseline to 113.1 mg/dL at 6 months (P < .0001), in the lovastatin groups and was largely unchanged in the lovastatin-placebo groups. Among participants not on warfarin, regression of the mean maximum IMT was seen after 12 months in the lovastatin group compared with the placebo group; the 3-year difference was statistically significant (P = .001). A larger favorable effect of lovastatin was observed for the change in single maximum IMT but was not statistically significant (P = .12). Five lovastatin-treated participants suffered major cardiovascular events--coronary heart disease mortality, nonfatal myocardial infarction, or stroke--versus 14 in the lovastatin-placebo groups (P = .04). One lovastatin-treated participant died, compared with eight on lovastatin-placebo (P = .02).. In men and women with moderately elevated LDL cholesterol, lovastatin reverses progression of IMT in the carotid arteries and appears to reduce the risk of major cardiovascular events and mortality. Results from ongoing large-scale clinical trials may further establish the clinical benefit of statins.

Topics: Adult; Aged; Arteriosclerosis; Cardiovascular Diseases; Carotid Artery Diseases; Double-Blind Method; Female; Humans; Lovastatin; Male; Middle Aged; Risk Factors; Survival Analysis; Tunica Intima; Tunica Media; Ultrasonography; Warfarin

An NHLBI-sponsored randomized, double-masked, placebo-controlled, multicenter clinical trial is underway to test the efficacy of the lipid-lowering agent lovastatin and/or the antithrombotic agent warfarin in slowing the progression of early carotid atherosclerosis--as defined by ultrasonographic intimal-medial arterial wall thickening--in a high-risk, asymptomatic population consisting of 919 men and women aged 40-79 years with moderately elevated serum LDL-cholesterol. The Asymptomatic Carotid Artery Plaque Study's (ACAPS) factorial design permits evaluation of each of the two treatments alone as well as assessment of the treatments in combination with each other over a 2.5- to 3.0-year treatment period. Randomized participants receive either 20-40 mg/day lovastatin or lovastatin placebo and either 1 mg/day (minidose) warfarin or warfarin placebo. All participants were encouraged to take low-dose (81 mg/day) aspirin. The primary outcome is the ultrasonographic measurement of the mean of maximum intimal-medial thickness (IMT) across up to 12 preselected segments in the carotid arteries. The secondary outcome of the trial measures the single maximum IMT measurement among the same preselected carotid artery segments. This report describes the rationale for ACAPS, its design, and some baseline characteristics of the study population.

Topics: Adult; Aged; Arteriosclerosis; Carotid Artery Diseases; Drug Therapy, Combination; Female; Humans; Lovastatin; Male; Middle Aged; Patient Compliance; Research Design; Risk Factors; Statistics as Topic; Ultrasonography; Warfarin

Extracranial carotid artery aneurysms (ECAA) are extremely rare, accounting for less than 1% of all peripheral artery aneurysms. The most common presentation is central neurologic dysfunction, typically due to embolization of thrombus from the aneurysm. Historically open surgical intervention is the treatment of choice for symptomatic ECAA. Recent data suggest that endovascular repair is a valuable alternative, with a high procedural success rate and relatively low complication rate. We present a case of an ECAA with symptoms of vision loss, successfully treated by endovascular covered stenting but complicated by late in stent thrombosis and cerebral infarction. The patient was subsequently treated with IV thrombolysis and life-long warfarin. The patient had discrete residual symptoms at follow-up 3 months later.

Topics: Aneurysm; Anticoagulants; Carotid Artery Diseases; Endovascular Procedures; Female; Graft Occlusion, Vascular; Humans; Middle Aged; Stents; Thrombolytic Therapy; Thrombosis; Warfarin

A 67-year-old woman developed weakness of the entire left side of the body and disturbance of consciousness, and was admitted to our hospital. She had atrial fibrillation (AF) on arrival at the hospital. Diffusion weighted magnetic resonance imaging showed high intensity area in the right basal ganglia, and magnetic resonance angiography showed occlusion of the right internal carotid artery (ICA). Thrombolytic therapy with intravenous tissue plasminogen activator (IV tPA) was administered 225 minutes after onset, and endovascular procedure also performed. After endovascular therapy, the patient had successful recanalization of the right ICA. Transesophageal echocardiography (TEE) showed a mass in the left atrium. Cardiac surgery for the excision of a left atrial mass and the maze procedure for atrial fibrillation were performed on the 29th hospital day. The mass was pathologically confirmed as thrombus. Follow up TEE after cardiac surgery revealed recurrence of thrombus at the both origin of pulmonary vein in the left atrium. Finally, the thrombus was disappeared at 6-month after onset with taking warfarin. She had no stroke events during the clinical course.

Topics: Aged; Anticoagulants; Arterial Occlusive Diseases; Atrial Fibrillation; Cardiac Surgical Procedures; Carotid Artery Diseases; Carotid Artery, Internal; Diffusion Magnetic Resonance Imaging; Echocardiography, Transesophageal; Endovascular Procedures; Female; Heart Atria; Heart Diseases; Humans; Intracranial Embolism; Magnetic Resonance Angiography; Recurrence; Thrombosis; Treatment Outcome; Warfarin

Central retinal artery occlusion (CRAO) is a devastating ocular emergency characterized by acute painless visual loss in the ipsilateral eye. We describe the case of acute non-arteritic CRAO associated fusiform internal carotid-ophthalmic artery aneurysm with intraluminal thrombus. Despite the rarity of this condition, we suggest that carotid-ophthalmic artery aneurysm should be included in the differential diagnosis of CRAO.

Topics: Adult; Anticoagulants; Blindness; Carotid Artery Diseases; Carotid Artery, Internal; Female; Functional Laterality; Humans; Magnetic Resonance Imaging; Ophthalmic Artery; Retinal Artery Occlusion; Warfarin

Extracranial carotid artery fibromuscular dysplasia (FMD) is a rare finding that is frequently incidental and asymptomatic. It usually occurs in middle-age women and is secondary to medial fibrodysplasia or, less commonly, intimal fibrodysplasia. The carotid artery may be elongated or kinked and associated aneurysms have been reported. Symptoms including transient ischemic attack or stroke are uncommon and are due to low flow or embolization of platelet aggregates. Digital subtraction angiography demonstrates high-grade stenosis with the characteristic "string of beads" pattern. Antiplatelet medication with sequential imaging is the accepted therapy for asymptomatic lesions. Graduated endoluminal dilation under direct vision should be reserved for patients with documented lateralizing symptoms.

Topics: Angiography, Digital Subtraction; Carotid Artery Diseases; Constriction, Pathologic; Female; Fibromuscular Dysplasia; Humans; Middle Aged; Warfarin

Orbital infarction syndrome is defined as ischemia of global intraorbital structures such as extraocular muscles, optic nerves, and retina. The most common cause of this syndrome is carotid arterial occlusion. Other causes include vasculitis, vasospasm, and compression of intraorbital circulation. There has never been reported a case of orbital infarction syndrome in nephrotic syndrome patient. We present a case of 42-year-old Thai man with underlying disease nephrotic syndrome presented with abrupt onset of headache at left temporal area, horizontal diplopia, limitation of eye movement in all directions, ptosis, and blurred vision on the left eye. He was treated with pulse methylprednisolone intravenously for 3 days. Leg edema was improved however, the eye symptoms persisted. There was no evidence of hypercoagulable state. Magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) revealed loss of signal intensity at left internal carotid artery from base of skull to intracavernous part. Cerebral angiography demonstrated complete occlusion of left common carotid artery. After the anticoagulant treatment, his symptoms were gradually improved. The cause of extensive carotid arterial occlusion in this patient is most likely from hypercoagulable state. Although it was negative for hypercoagulable state evidence, the authors assume that the high dose steroid treatment could lead to remission of nephrotic syndrome and resulting in the resolution of hypercoagulable state.

Topics: Adult; Anticoagulants; Carotid Artery Diseases; Carotid Stenosis; Cerebral Infarction; Humans; Male; Orbital Diseases; Syndrome; Warfarin

Topics: Aged; Aged, 80 and over; Anticoagulants; Arterial Occlusive Diseases; Carotid Artery Diseases; Coronary Angiography; Coronary Artery Bypass; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Female; Fibrinolytic Agents; Heart Septal Defects, Atrial; Heparin; Humans; Hypertension; Intraoperative Complications; Intraoperative Period; Popliteal Vein; Subclavian Artery; Thrombolytic Therapy; Tissue Plasminogen Activator; Warfarin

A case of spontaneous internal carotid artery (ICA) dissection confined to the intrapetrous carotid canal that was confirmed by angiography and magnetic resonance imaging is presented. Isolated dissection involving the intrapetrous ICA is rare; however, whenever arterial dissection is a consideration, specific review of imaging in this region is warranted.

Topics: Adult; Angiography, Digital Subtraction; Anticoagulants; Carotid Artery Diseases; Carotid Artery, Internal; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Warfarin

Medically refractory positional cerebral ischemia and concomitant orthostatic hypotension associated with chronic common carotid artery (CCA) occlusion are rare. The authors detail their experience with three cases treated exclusively by an extracranial bypass in which the thyrocervical trunk was used as the donor vessel. Postoperatively grafts were patent and symptoms resolved in all three patients, although orthostatic hypotension remained. Postural cerebral ischemia due to CCA occlusion can be treated by extracranial bypass surgery. The thyrocervical trunk is a suitable donor for reconstruction of the external carotid artery in these cases.

Topics: Aged; Anticoagulants; Arterial Occlusive Diseases; Carotid Artery Diseases; Carotid Artery, Common; Carotid Artery, External; Cerebral Angiography; Cerebral Revascularization; Dizziness; Ephedrine; Fludrocortisone; Humans; Hypotension, Orthostatic; Ischemic Attack, Transient; Middle Aged; Paresis; Posture; Tomography, Emission-Computed, Single-Photon; Vision Disorders; Warfarin

The authors describe a 46-year-old Japanese woman who had Takayasu's arteritis associated with nephrotic syndrome due to mesangial proliferative glomerulonephritis with crescent. Although a few cases of focal and segmental mesangial proliferative glomerulonephritis associated with Takayasu's arteritis have been reported, nephrotic syndrome has not been reported previously in this situation.

Topics: Anti-Inflammatory Agents; Anticoagulants; Carotid Artery Diseases; Female; Glomerulonephritis, Membranoproliferative; Heparin; Humans; Middle Aged; Nephrotic Syndrome; Prednisolone; Proteinuria; Takayasu Arteritis; Warfarin

Carotid angioplasty and stenting is gaining in popularity as an alternative to carotid endarterectomy for the treatment of symptomatic critical stenoses of the internal carotid artery. However, the durability of this technique and the incidence of recurrent stenoses has not yet been fully evaluated. It has been reported that mechanical factors may cause deformity of a Palmaz stent, negating the initial benefits of the procedure. We describe successful carotid endarterectomy after distortion of a Strecker balloon-expandable stent.

Topics: Angioplasty; Anticoagulants; Aspirin; Carotid Artery Diseases; Carotid Artery, Internal; Carotid Stenosis; Endarterectomy, Carotid; Equipment Failure; Follow-Up Studies; Granuloma, Foreign-Body; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Polyethylene Terephthalates; Prostheses and Implants; Recurrence; Stents; Ultrasonography, Doppler, Duplex; Warfarin

To describe the atypical localization and unusual clinical manifestation of an internal carotid artery dissection.. We examined a 43-year-old woman who had sudden onset of left ptosis and miosis with vague dysesthesia around her eye.. Her examination showed an intrapetrous carotid artery dissection.. The intrapetrous segment is an extremely rare localization for an internal carotid artery dissection. The differential diagnosis of acute Horner syndrome should include carotid dissection, which is usually accompanied by other neurologic manifestations.

Topics: Adult; Anticoagulants; Aortic Dissection; Blepharoptosis; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Angiography; Diagnosis, Differential; Female; Heparin; Horner Syndrome; Humans; Petrous Bone; Warfarin

A subject with dissection of the internal carotid artery (ICA) may present with a variety of symptoms, from headache to stroke. Thus far, it has not been possible to identify the subset of patients at risk for cerebral ischemia. Because the majority of these ischemic events are secondary to embolic phenomena, we used transcranial Doppler (TCD) evaluation with emboli monitoring to study 17 consecutive patients with ICA dissection treated at Harborview Medical Center, Seattle, Wash, during a 2-year period from 1992 until 1994.. Ten patients with ICA dissection secondary to trauma and seven with spontaneous ICA dissection were diagnosed by carotid angiography and studied by TCD from the time of diagnosis through initiation of therapy. Emboli monitoring was performed in the middle cerebral artery (MCA) ipsilateral to the dissection at the initial evaluation and intermittently thereafter to ensure that the emboli stopped with treatment.. Emboli were detected in the MCA distal to the dissection in 10 of 17 patients (59%). Patients with microemboli detected by TCD presented with a stroke (70%) much more frequently than those without emboli (14%) (P=.0498). The presence of a pseudoaneurysm did not increase the risk of either microemboli or stroke.. We have demonstrated a high incidence of intracranial microemboli in the MCA distal to carotid dissections and a significant correlation between the presence of emboli and stroke. TCD can therefore be used as an adjunctive tool to manage patients with suspected carotid dissection and may prove useful in evaluating the efficacy of treatment in reducing microemboli and subsequent stroke.

Topics: Adolescent; Adult; Anticoagulants; Aortic Dissection; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Angiography; Cerebral Arteries; Cerebrovascular Disorders; Child; Female; Heparin; Humans; Intracranial Embolism and Thrombosis; Male; Middle Aged; Ultrasonography, Doppler, Transcranial; Warfarin; Washington

Topics: Aortic Dissection; Carotid Artery Diseases; Carotid Artery, Internal; Diagnosis, Differential; Fibromuscular Dysplasia; Follow-Up Studies; Heparin; Humans; Male; Middle Aged; Recurrence; Warfarin

To determine whether anticoagulation practices have changed when heparin and warfarin are used to treat cerebrovascular disease, and to determine the dosage of aspirin used to treat carotid territory transient ischemic attacks (TIAs).. A 1987 study documented that neurologists and neurology house officers were using excessive amounts of heparin and warfarin. Recent studies have demonstrated the efficacy and safety of low-intensity anticoagulation for preventing strokes, but no data are available on how these findings have affected the treatment practices of clinicians.. Questionnaires were sent to neurology staff at 10 medical centers. The questions dealt with the use of heparin, warfarin, and aspirin in stroke/transient ischemic attack patients. The nonparametric Wilcoxon rank sum test was used for analyzing the responses.. Ninety-three physicians responded compared with 52 in the prior study. Most (56 of 92; 61%) did not use an IV heparin bolus. The mean partial thromboplastin time (PTT) was 55 seconds, which was significantly less than the mean PTT of 62 seconds (p = 0.006) in the prior study. The mean prothrombin time (PT) fell to 16.0 seconds (range, 12.5 to 20.0) compared with a mean of 19.9 seconds (range, 15.0 to 27.0; p < 0.001) in the earlier study. There was a significant fall in the mean PT ratio from 1.74 (range, 1.20 to 2.25) to 1.49 (range, 1.12 to 2.50; p < 0.001). Most respondents used 325 mg qd of aspirin for treating TIAs.. At the centers studied, neurologists and neurology house officers are using less intense anticoagulation when treating stroke patients now than in 1986. This concurs with recent studies demonstrating the efficacy and safety of low-intensity anticoagulation in some clinical settings. The use of 325 mg/d of aspirin is common, although the data supporting its efficacy compared with higher doses are unclear.

Topics: Anticoagulants; Aspirin; Carotid Artery Diseases; Cerebrovascular Disorders; Data Collection; Follow-Up Studies; Heparin; Humans; Ischemic Attack, Transient; Neurology; Practice Patterns, Physicians'; Surveys and Questionnaires; Warfarin

Cervical internal carotid dissection is not rare. Doppler ultrasound screening of young patients presenting with stroke, identified 10 patients with reduced common and internal carotid blood flow without any evidence of atheroma. Eight, on angiography proved to have a dissection of the cervical internal carotid artery. All were managed conservatively. Seven received anticoagulant therapy, stopping any further neurological symptoms.

Topics: Adolescent; Adult; Aortic Dissection; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Angiography; Cerebral Infarction; Echoencephalography; Female; Follow-Up Studies; Heparin; Humans; Intracranial Aneurysm; Ischemic Attack, Transient; Male; Middle Aged; Tomography, X-Ray Computed; Warfarin

Topics: Carotid Artery Diseases; Carotid Artery, Internal; Echocardiography; Female; Heart Septal Defects, Atrial; Humans; Intracranial Embolism and Thrombosis; Ischemic Attack, Transient; Middle Aged; Radiographic Image Enhancement; Warfarin

Facial numbness and dysesthesia have not been emphasized as presenting features in spontaneous internal carotid artery dissection. Progressive facial pain, accompanied by oculosympathetic paresis, altered taste, and facial numbness suggest the possibility of basal skull neoplasm. We describe a patient, with previously undiscovered fibromuscular dysplasia, who presented with severe neck and face pain, dysgeusia, oculosympathetic paresis, and markedly reduced facial sensation due to a spontaneous vascular dissection. Altered facial sensation should now be included in the symptomatology of internal carotid artery dissection.

Topics: Aortic Dissection; Carotid Artery Diseases; Carotid Artery, Internal; Face; Facial Pain; Female; Heparin; Humans; Middle Aged; Nervous System Diseases; Radiography; Sensation; Taste Disorders; Warfarin

Fourteen patients with angiographically demonstrated thrombus in the cerebral vessels were treated immediately with anticoagulant or antiplatelet medication. Follow-up angiograms, obtained in eight cases, showed resolution of the thrombus in seven. In no patient did the thrombus progress to occlude the vessel completely, and no new distal emboli were identified on the follow-up angiograms. There were no new permanent neurologic events in these 14 patients while they were undergoing medical therapy. Six patients subsequently underwent delayed endarterectomy to treat underlying stenoses. Our experience indicates that the presence of intraluminal thrombus may not be a surgical emergency.

Topics: Adult; Aged; Angiography; Aspirin; Carotid Artery Diseases; Carotid Artery, Internal; Female; Heparin; Humans; Male; Middle Aged; Thrombosis; Warfarin

Topics: Adult; Angiography; Arterial Occlusive Diseases; Carotid Artery Diseases; Carotid Artery Injuries; Carotid Artery, Internal; Electroencephalography; Hematoma; Humans; Male; Mental Disorders; Physical Therapy Modalities; Rupture; Ultrasonography; Vasa Vasorum; Warfarin

Topics: Animals; Blood Coagulation; Carotid Artery Diseases; Female; Hemorrhage; Hemostasis; Heparin; Male; Prothrombin Time; Rats; Thrombosis; Warfarin

Topics: Arteriosclerosis; Cardiovascular Diseases; Carotid Artery Diseases; Cerebral Angiography; Cerebrovascular Disorders; Dextrans; Hematologic Diseases; Heparin; Humans; Infarction; Injections, Intravenous; Ischemic Attack, Transient; Papaverine; Subclavian Steal Syndrome; Vertebral Artery; Warfarin