{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:17:05Z","timestamp":1761823025526},"reference-count":6,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2007,12]]},"abstract":"<jats:p>\u2713Both carotid endarterectomy and carotid artery stent placement with filter embolic protection present a higher risk for patients with internal carotid artery (ICA) lesions containing intraluminal thrombus. Despite the risk associated with intervention, patients with symptomatic intraluminal thrombus who were enrolled in the North American Symptomatic Endarterectomy Trial did better with surgical than medical treatment. We describe the novel use of an endovascular \u201cinternal cross-clamping\u201d technique in two patients with symptomatic intraluminal thrombus in the ICA. A 57-year-old woman presented with a history of multiple episodes of left upper-extremity numbness, mild dysarthria, and agraphia occurring over the previous 24 hours. Cranial magnetic resonance imaging revealed a scattered watershed infarction of the right hemisphere and a critical stenosis of the right ICA. An 81-year-old man awoke with hemiplegia and inability to follow commands after undergoing a complicated carotid endarterectomy. Computed tomographic perfusion imaging demonstrated an increased time to peak in the left middle cerebral territory, and emergent angiography demonstrated both intimal flaps and thrombus in the endarterectomy bed. The lesions in both patients were treated with endovascular stent placement using both proximal and distal flow occlusion\u2014a functional \u201cinternal cross-clamping\u201d\u2014for embolic protection. To our knowledge, this is the first report of internal trapping and stent placement for symptomatic carotid stenosis containing intraluminal thrombus. This treatment strategy should be added to the armamentarium of endovascular surgeons in selected patients with symptomatic carotid intraluminal thrombus.<\/jats:p>","DOI":"10.3171\/jns-07\/12\/1223","type":"journal-article","created":{"date-parts":[[2007,12,13]],"date-time":"2007-12-13T18:51:54Z","timestamp":1197571914000},"page":"1223-1227","source":"Crossref","is-referenced-by-count":8,"title":["\u201cInternal cross-clamping\u201d for symptomatic internal carotid artery thrombus"],"prefix":"10.3171","volume":"107","author":[{"given":"Robert D.","family":"Ecker","sequence":"first","affiliation":[{"name":"Department of Neurosurgery and Toshiba Stroke Research Center;"},{"name":"US Naval Hospital, Okinawa, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramachandra P.","family":"Tummala","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Toshiba Stroke Research Center;"},{"name":"Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York;"},{"name":"Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elad I.","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Toshiba Stroke Research Center;"},{"name":"Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York;"},{"name":"Department of Radiology, School of Medicine and Biomedical Sciences, State University of New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. Nelson","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Toshiba Stroke Research Center;"},{"name":"Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York;"},{"name":"Department of Radiology, School of Medicine and Biomedical Sciences, State University of New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-1071223","series-title":"J Endovasc Ther","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1177\/152660280200900202","article-title":"Use of the Parodi anti-embolism system in carotid stenting: Italian trial results","volume":"9","author":"Adami","year":"2002"},{"key":"b2-1071223","series-title":"CMAJ","first-page":"1169","article-title":"North American Symptomatic Carotid Endarterectomy Trial (NASCET) collaborators: the appropriate use of carotid endarterectomy","volume":"166","author":"Barnett","year":"2002"},{"key":"b3-1071223","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1212\/WNL.34.9.1175","article-title":"Intraluminal clot of the carotid artery detected radiographically","volume":"34","author":"Caplan","year":"1984"},{"key":"b4-1071223","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1161\/01.STR.25.6.1116","article-title":"Multicenter review of preoperative risk factors for carotid endarterectomy in patients with ipsilateral symptoms","volume":"25","author":"Goldstein","year":"1994"},{"key":"b5-1071223","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1148\/radiology.160.2.3726115","article-title":"Intraluminal thrombus of the internal carotid arteries: angiographic demonstration of resolution with anticoagulant therapy alone","volume":"160","author":"Pelz","year":"1986"},{"key":"b6-1071223","series-title":"Stroke","first-page":"276","article-title":"Prognosis of patients with intraluminal thrombosis in the internal carotid artery: North American Symptomatic Carotid Endarterectomy Trial","volume":"29","author":"Villareal","year":"1998"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/107\/6\/article-p1223.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/107\/6\/article-p1223.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/107\/6\/article-p1223.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T01:12:29Z","timestamp":1681348349000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/107\/6\/article-p1223.xml"}},"subtitle":["Report of two cases"],"short-title":[],"issued":{"date-parts":[[2007,12]]},"references-count":6,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/jns-07\/12\/1223","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,12]]}}}