Abstract
A 83-year-old man with a history of transient ischemic attack (TIA) was referred to our hospital with dysarthria, left-sided facial palsy, and weakness of the left arm. For the secondary prevention of ischemic stroke, warfarin was administered because he had non-valvular arterial fibrillation. Magnetic resonance imaging of the brain revealed multiple infarctions at the right middle cerebral artery. Carotid ultrasonography revealed severe stenosis at the right internal carotid artery with a mobile structure. After administration of combined antithrombotic therapy with dabigatran and aspirin, repeated carotid ultrasonography revealed serial reduction of the mobile structure, and disappeared on day 66. On day 101, the right internal carotid artery successfully underwent carotid artery stenting. After 1 year, neither recurrence of ischemic stroke nor new mobile structures had been noted. These findings allowed us to diagnose the mobile structure as thrombus. This case suggests that combination therapy with non-vitamin K oral anti-coagulant and aspirin is an appropriate therapeutic option for mobile plaques on carotid artery stenosis in patients with non-valvular arterial fibrillation.
