Int J Angiol 2021; 30(02): 170-172
DOI: 10.1055/s-0040-1720973
Case Report

Free-Floating Thrombus in the Distal Internal Carotid Artery Causing a Stroke

Spyros Papadoulas
1   Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
,
Konstantinos Moulakakis
1   Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
,
Natasa Kouri
1   Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
,
Petros Zampakis
2   Departement of Radiology, University Hospital of Patras, Patras, Greece
,
Stavros K. Kakkos
1   Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
› Author Affiliations

Abstract

We present a patient suffering from a stroke with a free-floating thrombus extending up to the distal internal carotid artery. The thrombus was totally resolved after a 2-week anticoagulation regimen without leaving behind any severe residual stenosis in the carotid bulb. The optimal treatment of this rare condition remains uncertain. We report some important treatment strategies that have been used in the literature, emphasizing the anticoagulation as the mainstay of therapy. Immediate surgical and interventional manipulations carry the risk of thrombus dislodgement and embolization and should be considered if there are recurrent symptoms despite medical management.



Publication History

Article published online:
26 November 2020

© 2020. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Bhogal P, AlMatter M, Aguilar Pérez M, Bäzner H, Henkes H, Hellstern V. Carotid stenting as definitive treatment for free floating thrombus-review of 7 cases. Clin Neuroradiol 2020
  • 2 Fridman S, Lownie SP, Mandzia J. Diagnosis and management of carotid free-floating thrombus: a systematic literature review. Int J Stroke 2019; 14 (03) 247-256
  • 3 Bhatti AF, Leon Jr. LR, Labropoulos N. et al. Free-floating thrombus of the carotid artery: literature review and case reports. J Vasc Surg 2007; 45 (01) 199-205
  • 4 Lee JI, Jander S, Oberhuber A. et al. Stroke in patients with occlusion of the internal carotid artery: options for treatment. Expert Rev Neurother 2014; 14 (10) 1153-1167
  • 5 Yamaoka A, Miyata K, Iihoshi S, Mikuni N. Endovascular treatment of asymptomatic free-floating thrombus in the carotid artery bifurcation: a direct aspiration first-pass technique under double balloon protection. BMJ Case Rep 2019; 12 (08) e230295
  • 6 Fitzpatrick N, Motyer R, Gibney B. et al. Expanding the role of stent-retriever endovascular thrombectomy: a case series of free-floating thrombus. J Neurointerv Surg 2018; 10 (12) 1164-1167
  • 7 Mokin M, Kass-Hout T, Kass-Hout O. et al. Intravenous heparin for the treatment of intraluminal thrombus in patients with acute ischemic stroke: a case series. J Neurointerv Surg 2013; 5 (02) 144-150
  • 8 Vellimana AK, Kadkhodayan Y, Rich KM. et al. Symptomatic patients with intraluminal carotid artery thrombus: outcome with a strategy of initial anticoagulation. J Neurosurg 2013; 118 (01) 34-41
  • 9 Powers WJ, Rabinstein AA, Ackerson T. et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019; 50 (12) e344-e418
  • 10 Tolaymat B, Irizarry K, Reif M. et al. Considerations beyond stenosis for carotid endarterectomy in treating free-floating thrombus of the carotid artery. Ann Vasc Surg 2019; 60: 221-228