Floating carotid thrombus treated by intravenous heparin and endarterectomy

Among different subtypes of ischemic stroke, atherosclerotic stroke carries the greatest risk (30%) of worsening and recurrence during the acute phase of hospitalization with a 7.9% risk <= 30 days. Causes of this high risk include plaque rupture leading to thrombus formation, thrombus propagation with consequent vessel occlusion, and distal embolism. In this context, emergent endartereetomy or anticoagulation, followed by deferred endarterectomy, are both controversial. We report a patient with an ischemic stroke caused by thromboembolism from an ulcerated plaque with floating thrombus of the internal carotid artery (ICA). A controversial use of heparin is discussed. (J Vase Surg 2011;53:489-91.)