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Background <p>Carotid free-floating thrombi (CFFT) are uncommon but pose a high risk of embolic stroke. While vascular intervention is often favored, this case study demonstrates the potential of short-term anticoagulation, guided by thorough imaging, as an alternative treatment strategy.</p> Case presentation <p>We present a patient with an acute ischemic stroke (NIHSS 15) due to middle cerebral artery (MCA) occlusion. Intravenous alteplase successfully revascularized the MCA. However, subsequent imaging revealed a CFFT as the likely source of the occlusion. Rather than immediate surgical intervention, we opted for a treatment strategy guided by comprehensive radiological assessments, including high-resolution MRI and serial ultrasounds. These assessments suggested the thrombus was newly formed. Based on this, we hypothesized it would be responsive to anticoagulation. Indeed, short-term enoxaparin therapy resulted in significant resolution of the CFFT.</p> Conclusions <p>This case highlights the efficacy of anticoagulation for treating newly formed CFFT, suggesting a potential alternative to immediate intervention when guided by detailed radiological evaluation. This case introduces a novel approach that may expand treatment options for this challenging condition.</p>

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Rapid resolution of newly formed carotid free-floating thrombus through anticoagulation therapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月12日

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  • Fuli Xie,
  • Lili Liang,
  • Yuzhou Wang

摘要

Background

Carotid free-floating thrombi (CFFT) are uncommon but pose a high risk of embolic stroke. While vascular intervention is often favored, this case study demonstrates the potential of short-term anticoagulation, guided by thorough imaging, as an alternative treatment strategy.

Case presentation

We present a patient with an acute ischemic stroke (NIHSS 15) due to middle cerebral artery (MCA) occlusion. Intravenous alteplase successfully revascularized the MCA. However, subsequent imaging revealed a CFFT as the likely source of the occlusion. Rather than immediate surgical intervention, we opted for a treatment strategy guided by comprehensive radiological assessments, including high-resolution MRI and serial ultrasounds. These assessments suggested the thrombus was newly formed. Based on this, we hypothesized it would be responsive to anticoagulation. Indeed, short-term enoxaparin therapy resulted in significant resolution of the CFFT.

Conclusions

This case highlights the efficacy of anticoagulation for treating newly formed CFFT, suggesting a potential alternative to immediate intervention when guided by detailed radiological evaluation. This case introduces a novel approach that may expand treatment options for this challenging condition.