Carotid Stenting as Definitive Treatment for Free Floating Thrombus—Review of 7 Cases

Abstract

Background and Purpose Free floating thrombus (FFT) is a rare condition. The optimal treatment strategy is yet to be determined although medical management with anticoagulation is the mainstay. This article reports experience of treating FFT with carotid stenting. Methods A retrospective analysis of a prospectively maintained database was performed to identify all patients with FFT treated with carotid stenting. For each patient the demographic data, clinical presentation, location of the thrombus, type of stent and use of adjunctive devices, e.g. balloon guide catheters, clinical and radiological follow-up information as well as complications were recorded. Results A total of 7 patients, 4 female, with mean age of 55.6 ± 14.5 years were identified. The median National Institutes of Health Stroke Scale (NIHSS) was 7 (range 0-13) at presentation. Free floating thrombus was seen on the left in the majority of cases (n = 6, 85.7%). None of the patients had intracranial large vessel occlusion. The FFT was located in the CCA in 2 cases (28.6%) and the proximal ICA in the remaining 5 cases (71.4%). The Wallstent was used in 5 patients and a cGuard stent used in 2 patients. In 1 patient 2 overlapping stents were used but a single stent was used in the remaining patients. In 6 cases a distal filter wire was used and in 2 cases a balloon guide catheter was used as embolic protection. There were no intraoperative complications and no cases of distal clot migration or intracranial large vessel occlusion during the procedure. At last follow-up (n = 7) 6 patients were recorded as modified Rankin Scale (mRS) Ä2 and 1 patient was mRS 3. Conclusion Free floating thrombus of the carotid arteries can be managed with stenting.

Huge Free-Floating Thrombus in the Internal Carotid Artery Under Duplex Ultrasound Surveillance

“…Although, as the patients have benefits from the anticoagulation and antiplatelet therapy or surgical approaches in previous reports. 4 , 5 Which is the most appropriate management for FFT still needs to be individualized by detailed arterial imaging evaluation and dynamic monitoring of the thrombus.…”

Free-floating thrombus and a fragment of atherosclerotic plaque in the lumen of the internal carotid artery – review of 2 cases

“…Оптимальну стратегію лікування не визначено через рідкісність захворювання, а також брак порівняльних досліджень консервативного (антикоагулянтна та/або дезагрегантна терапія) і хірургічного лікування (стентування сонної артерії, ендоваскулярна тромбектомія, ендартеректомія) [6].…”

Triple Stentriever “Bouquet” Deployment with Zoom 88 Large-Bore Aspiration and Walrus Balloon-Guide Catheter for the Definitive Thrombectomy of a Carotid Free-Floating Thrombus

“…5 There have been several recent reports about the successful mechanical thrombectomy of CFFT. [6][7][8][9][10][11][12][13][14][15][16][17] These studies have demonstrated the challenges of safely performing mechanical thrombectomy due to significant clot burden, lack of tools, and techniques designed to perform cerebrovascular thrombectomy. In total, the literature to date has provided no conclusive techniques for safe and reliable removal of CFFTs.…”

“…In total, the literature to date has provided no conclusive techniques for safe and reliable removal of CFFTs. 5,18 Recent technological improvements in aspiration catheters and stentrievers has made mechanical thrombectomy of cerebral vessels increasingly safe [6][7][8][9][10][11][12][13][14][15][16][17] and effective. 19,20 Among these developments are large-bore aspiration catheters (0.088" ID) 21,22 that are built both with and without compliant balloons for flow arrest and aspiration/flow reversal.…”