Is there a role for using parenteral anticoagulation for occlusive extensive ICA thrombus with acute onset of symptoms when patients are not candidates for endovascular therapy, such as low NIHSS?  

If interpreting the question correctly, it refers to an extensive/occlusive thrombus in the ICA as an acute vessel occlusion? In such cases, my decision between the medical and endovascular approaches largely depends on the segmental location of the occlusion. For a proximal cervical-segment ICA occ...

Assuming that this is an acute thrombus and if the patient is not a thrombectomy candidate or CEA for fresh occlusion (even until then for medical management, the following can be considered), then to prevent thrombus propagation, I would start low-dose IV heparin without bolus (or half bolus if the...