Occurrence of Simultaneous Left Ventricular Mural Thrombus and a Fresh Floating Thrombus in the Left Common Carotid Artery

Stroke is the third-leading cause of death in the United States after cardiovascular disease and cancer. It remains the leading cause of serious long-term disability in the United States. Mechanisms of ischemic stroke include embolism, decreased perfusion, and thrombosis. Cardio-embolism, defined as a source of embolus originating from the heart, may account for an estimated 20% of ischemic strokes. Intracavity thrombus from wall motion abnormalities, especially in the first 2 weeks after anterior myocardial infarction, has been described as a potential cardiac source of emboli. The finding of an LV apical thrombus detected by transthoracic echocardiography as a possible embolic source and the simultaneous discovery of a fresh floating thrombus in the left common carotid artery as detected by duplex ultrasonography are rare findings. We report a case of a 77-year-old man with both of these findings with signs and symptoms of a myocardial infarction with late presentation. Trans-thoracic echocardiography revealed an echo density consistent with mural thrombus that was located adjacent to the severely hypokinetic left ventricular apical wall. A carotid duplex revealed a totally occluded left common carotid artery with an echo density suggestive of thrombus. Atheromatous deposits in the extra-cranial carotid arteries may cause localized thrombosis. However, a free-floating thrombus in the carotid artery could be a result of a cardiac source of embolism. Cardioembolic syndromes typically presents as emergencies. Prompt diagnosis and urgent optimal medical and surgical treatments are warranted because these patients have an increased risk for distal embolization and vessel occlusion that lead to severe disability or death.