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Top of the Carotid/Carotid T Occlusions


Learning objectives

  • Diagnose TOC strokes
  • Investigations of TOC strokes
  • Management of TOC strokes

Introduction

  • Top of the carotid at its bifurcation into ACA and MCA often called the carotid T
  • The shape of the lumen is T is filled with clot - ICA/MCA/ACA

Aetiology

  • Often embolic eg. AF
  • Artery to artery from carotid thrombus - atherosclerois or dissection
  • Other cardioembolic causes
  • Left ventricular thrombus formation after acute myocardial infarction
  • Cryptogenic stroke

Clinical

  • ACA stroke syndrome
  • MCA stroke syndrome

Investigations

  • CT may show dense artery +/- evolved stroke
  • MRI/A and CTA may show the occlusion
  • Aetiology: ECG, Echo, 24/48/7 day tape for AF

Management

  • Acute stroke care and reperfusion therapy - Thrombolysis and Thrombecotmy
  • Admit HASU. See Hyperacute care.

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