Floating aortic arch thrombus involving the left common carotid artery complicated with ischemic stroke associated with cocaine use

Abstract

Background Floating aortic thrombi (FLOAT) are rare, with very few cases attributed to cocaine use. We report a new case of FLOAT involving the left common carotid artery due to cocaine use, for the first time, complicated with acute ischemic stroke. Methods We present in detail our case report, and then, a literature search in PubMed and Scopus was performed up to March 20, 2022, to review the reported cases of aortic thrombus associated with cocaine use. Results A 39-year-old man with a history of smoking and daily cocaine use was admitted to our stroke unit for acute left-hemispheric symptoms due to carotid-Sylvian occlusion. CT angiography of the supra-aortic trunks showed FLOAT involving the left common carotid artery. The thrombus was removed successfully by endovascular thrombectomy with recanalization of carotid-Sylvian occlusion. Our literature search yielded seven reported cases of aortic thrombus due to cocaine use revealed by lower limb ischemia (3 patients), renal infarction (1 patient), abdominal pain (1 patient), bowel ischemia (1 patient), and lower limb ischemia with renal infarction (1 patient). Conclusion Aortic thrombus should be suspected in patients without overt cardiovascular risk factors but with a recent history of cocaine use who presents with acute ischemic stroke.

Spontaneous Coronary Sinus Thrombosis Detected by Point-of-care Transthoracic Echo: A Case Report

“…7 Previous reports discuss various cocaine-induced thromboses including deep vein thrombosis and pulmonary embolism, myocardial infarction from intracoronary thrombus despite normal coronary arteries, and floating aortic arch thrombus. [8][9][10] Our case suggests CST may similarly be triggered by cocaine use.…”

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

“…Although these reports have not demonstrated a standardized technique for the mechanical thrombectomy of CFFTs, numerous methods including stentrievers, reversal of carotid flow with occlusion balloons, and distal filter wire placement have been reported. [6][7][8][9][10][11][12][13][14][15][16][17] Recently, direct aspiration, with or without the utilization of proximal and distal protection devices have been described. 11,20,27 To harness all the benefits of previously reported techniques we employed a triple stentriever "bouquet" technique for the mechanical thrombectomy of a CFFT.…”

“…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.…”