Mechanical Thrombectomy of a Free-Floating Thrombus from the Proximal Internal Carotid Artery with a Carotid Filter Wire

Rarely discussed in the medical literature, free-floating thrombi (FFTs) present unique challenges with specific diagnostic criteria, including elongated shape, arterial wall attachment, circumferential blood flow, and cardiac cycle-related motion. FFTs are most frequently observed in the internal carotid artery (ICA). Advanced imaging, particularly computed tomography angiography (CTA), has refined the diagnosis and confirmed atherosclerosis as the primary cause. Although rare in stroke patients (0.4%), FFTs carry a high short-term risk of recurrent ischemic stroke. The therapeutic trend in the literature has been toward anticoagulation, with different treatments yielding different results. This chapter presents a novel application of a carotid filter to extract an FFT without stent implantation or administration of antiplatelet agents.