Management Of Free-floating Thrombus Research Articles

Comparative Efficacy of Procedural vs. Medical Interventions in the Management of Free-floating Thrombus: A Systematic Review and Meta-analysis (P7-5.002)

Comparative Efficacy of Procedural vs. Medical Interventions in the Management of Free-floating Thrombus: A Systematic Review and Meta-analysis (P7-5.002)

Management of free-floating thrombus in the arch of the aorta in a case of upper limb ischemia

Floating thrombus in a nonaneurysmal and nonatherosclerotic arch of the aorta is an extremely rare event with potential catastrophic complications. There is a risk of both systemic and cerebral embolization. We present a case of floating thrombus in the arch of the aorta who presented with left upper limb advanced ischemia. Confirmation of the diagnosis was done by computed tomography angiogram. His upper limb symptoms were relieved with thrombectomy, supported by medical line of treatment. For floating thrombus in the arch of the aorta, he was started on aggressive anticoagulation therapy, and there was significant resolution after 4 weeks and complete resolution after 3 months of the treatment. We report our experience with a very rare condition and make a proposal for therapeutic interventions.

Surgical Management of Free-floating Thrombus within the Common Carotid Artery

Free-floating thrombus (FFT) of the carotid artery is an exceptional medical condition with a currently unclarified pathophysiology. Approximately 150 cases have been described and published in the literature throughout the world so far. Thus, no definite management strategies have been established yet. In this paper, a symptomatic case of an FFT inside the common carotid artery presented with a history of slurred speech, and right sided hemiplegia was reported. After the diagnosis of a mobile thrombus within the origin of the left common carotid artery, the patient was placed on anticoagulation. As the medical therapy failed, carotid thromboendarterectomy was performed.

Management of free-floating thrombus within the arcus aorta and supra-aortic arteries

IntroductionClinical management strategy and the best treatment option of free floating thrombus (FFT), detected in patients with acute ischemic cerebrovascular diseases is still uncertain due to the rarity of these conditions. Recent studies emphasize that FFT within cerebral vessels may not be a surgical emergency since complete dissolution without any further neurologic progression occurred in 86% of patients treated medically.The aim of this study was to investigate the effect of medical treatment on the fate of thrombus and the clinical status in acute cerebrovascular event patients with detected FFT in the artery feeding the compromised brain territory at the time of diagnosis. Materials and methodsWe have retrospectively reviewed the initial and follow up computed tomography angiography, diffusion-weighted magnetic resonance imaging examinations of 37 acute ischemic stroke patients with detected FFT and treated medically. The patients were evaluated for any change of the FFT, residual stenosis after the FFT shrunk or disappeared and neurologic outcome. ResultsFFT was located in cervical carotid artery, intracranial artery and arcus aorta in 23, 6 and 5 of the patients respectively. Dissection accompanied the FFT in 3 patients. Recanalization was maintained in 34 patients however, three of them suffered from new infarctions. A total occlusion was detected in three patients. Two of them had new infarcts while one was stable during clinical follow-up period. ConclusionThe results of our retrospective study have shown that FFT in the proximal aorta and supra-aortic arteries tend to resolve with anticoagulant and/or antiplatelet treatment without causing recurrent adverse events in most of the cases. Furthermore, resolution of the clot seems to provide a safer ground for a recanalization procedure like stenting or endarterectomy if needed.

Computed tomography angiography evaluation of internal carotid artery free-floating thrombus—single-center diagnosis, false-positives, and follow-up

The incidence and management of free-floating thrombus (FFT), also known as intraluminal carotid thrombus, within the internal carotid artery (ICA) are currently unknown. The first case series documenting FFT was published in 1966 [1]. There have been numerous case series publications describing FFT using various modalities mostly including angiography, duplex ultrasound (DU), and more recently computed tomography (CT). Based on retrospective studies, its incidence is estimated to be between 0.4–0.7 % and 0.05 % at cerebral angiography and DU, respectively [2–4]. A more recent single-center retrospective analysis using CT angiography (CTA) quoted the incidence at 3.1 % [5]. With current guidelines for imaging of acute stroke and transient ischemic attack, CTA and magnetic resonance imaging angiography are more frequently being performed in the urgent setting [6]. More than 90 % of patients with FFT develop neurologic sequelae [7]. The “donut sign” has been used to describe the appearance of FFT in the axial plane on CTA [5]. Further characterization of FFT is possible with multiplanar reformatted images and may help distinguish FFT from other mimickers. We present the CTA findings of FFT and describe its potentially unstable clinical course and its resolution on imaging after treatment. Potential false-positives, including complex ulcerated plaque, will be discussed.

A big floating thrombus in the common carotid artery

The management of the free-floating thrombus (FFT) is difficult, and it is unclear whether surgical or medical treatment is superior. The common carotid artery is rarely involved. An 80-year-old woman presented with right hand weakness and syncope. Ultrasound showed the presence of FFT in the left common carotid artery. A carotid endarterectomy with Dacron patch angioplasty was immediately performed without complications. In the presence of symptoms, the interventional management of FFT is advised.

Diagnosis and Surgical Management of Free-Floating Thrombus Within the Carotid Artery

Free-floating thrombus (FFT) of the carotid artery is a rare condition of currently unknown etiology. Less than 150 cases have been described in the published world literature to date. We present 6 consecutive cases of carotid FFT, identified prospectively from 5000 carotid duplex scans over a 34-month period in a single tertiary center for vascular surgery. All 6 cases involved the left carotid bifurcation in neurologically symptomatic individuals. In 5 of the 6 cases, FFT occurred in the absence of a significantly stenosing atheromatous plaque and was not associated with an elevation in velocity on duplex. The patients were all treated with surgical thromboendarterectomy, with good result. Duplex imaging can underestimate the degree of stenosis. Free-floating thrombus presents a challenge in diagnosis due to its rapidly evolving nature. The management of FFT by acute thromboendarterectomy appears to be safe and effective in limiting further focal neurological sequelae.