We appreciate the comments of Drs. Tai and Sharma on our article “Idiopathic floating thrombus of the common carotid artery: Diagnosis and treatment options” (Jus 13(2): 57–60, 2010). This is indeed an interesting subject with important implications for clinical practice.
In our article, we intended to call attention to the possibility of a floating rather than an occluding thrombus of the common carotid. These two conditions produce different pathological pictures and must be managed in different ways. However, they also have certain features in common, such as the “artery-to-artery embolization” mechanism, which are often the cause of the clinical manifestations of this condition.
As far as occluding thrombosis of the common carotid is concerned, we agree with Drs. Tai and Sharma: thrombolysis is widely agreed to be very useful in improving the outcome of these cases. In the presence of a floating thrombus, however, this approach does not appear to offer any benefits in terms of the risk of cerebral hemorrhage. In fact, medical (i.e., anticoagulant) or surgical treatment carries a lower risk and produces good results.
In the absence of specific treatment guidelines, treatment strategies must be defined on a case-by-case basis. In this setting, we would like to underline the value of Transcranial Doppler. This method, which is often underused in clinical settings, can be of great help in choosing an appropriate treatment strategy and in monitoring the evolution of the thrombus during treatment and in later phases of follow-up.
To provide the best treatment possible, cases of this type must be managed in a Stroke Unit by a multidisciplinary team that includes not only a neurologist but also a vascular surgeon, an internist, and a neuroradiologist.