Background and Purpose: Deep venous thrombosis (DVT) in the upper part of the body is rare, accounting for approximately 1 – 4% of all DVTs. The incidence and clinical significance of jugular vein thrombosis (JVT) were investigated in consecutive patients with acute ischemic stroke. Subjects and Methods: From December 2006 to March 2007, 71 patients (46 men, aged 70.8 ± 13.2 years) hospitalized within 48 hours after ischemic stroke or TIA onset were retrospectively examined. The presence of JVT was evaluated by ultrasonography. Patients with jugular vein catheterization were not included. Age, sex, hypertension, diabetes mellitus, hyperlipidemia, smoking status, presence of a malignant tumor, and D-dimer were assessed. Results: JVT was demonstrated in four patients (5.6%). The rate of a malignant tumor was significantly higher in patients with JVT than in those without (100% vs. 14.9%, p<0.001). The tumors were as follows: esophageal cancer (1); lung cancer (1); and uterine cervical cancer (2). The stroke subtype in three patients was Trousseau syndrome with a high D-dimer value, and that in the other patient was a lacunar stroke with a normal D-dimer value. Conclusions: Ultrasonographic evidence of JVT in patients with acute ischemic stroke could be a marker of a coincidental malignant tumor with or without Trousseau syndrome.
A case of acute ischemic stroke with ipsilateral carotid artery stenosis and atrial fibrillation is reported. In this case, carotid artery stenting (CAS) was performed after the initiation of oral anticoagulation with warfarin and dual antiplatelet therapy with aspirin and clopidogrel. However, such triple therapy is thought to increase the risk of bleeding complications. Three months after the CAS, the clopidogrel was stopped, but the aspirin and warfarin were continued for another three months. After that, the aspirin was stopped, and oral warfarin was continued for more than two years. Repeated carotid ultrasonography revealed no in-stent re-stenosis. The patient had neither recurrent stroke nor cardiovascular events. If CAS is required in patients with atrial fibrillation, triple or double antithrombotic therapy is needed for several months; however, after this period, monotherapy with an oral anticoagulant appears to be safe.