Spontaneous free floating carotid artery thrombosis

Abstract

A 64-year-old man, with no history of trauma, presented with transient visual loss. He was diagnosed with amaurosis fugax and started on dipyridamole and simvastatin. An inconclusive ultrasound (US) Doppler was followed by CT angiogram (CTA) and MRI, which demonstrated free floating intraluminal thrombus in the distal right common carotid artery. ECG showed sinus rhythm and an echocardiogram showed no cardiac thrombus. Following discussion at the vascular multidisciplinary team the decision was made to treat with intravenous heparin followed by warfarin. He has been regularly followed up with CTA/USS, the most recent (Oct 2012) showing no evidence of thrombus. He has had no further symptoms. Despite no initial aetiology being found we suggest that his undiagnosed oesophageal carcinoma (diagnosed 5 months after initial presentation) could have been responsible for a hypercoagulability state giving an increased risk of thrombosis and leading to the thrombus in the common carotid artery.

Free-Floating Thrombus in the Carotid Artery: Two Different Etiologies and Treatment Approaches

“…The most common underlying cause is atherosclerosis, while other causes include hypercoagulation, autoimmune diseases, carotid artery aneurysm, dissection, cardiogenic embolism, cancer and trauma (6)(7)(8)(9). While hyperhomocysteinemia was found to be the cause of hypercoagulation in our first case, whereas for our second case the cause thereof was found to be tuberculosis.…”

“…The clinical picture usually begins acutely (in more than 90% of cases) and often causes recurrent transient ischemic attacks and acute stroke due to artery-to-artery distal embolism (microembolism). Atherosclerosis and hypercoagulation are the most frequently accused causes in the etiology (6)(7)(8)(9).…”

“…The possible pathogenic mechanism of free-floating thrombus is the formation of thrombus formation in that region as a result of intra-plaque hemorrhage or rupture of atherosclerotic plaque (7,8). There is no clear consensus on the treatment strategy [medical, surgical (endarterectomy), endovascular treatment].…”

Republished: Stentriever thrombectomy with distal protection device for carotid free floating thrombus: a technical case report

“…FFT of the carotid artery is extremely rare, with around 150 cases reported in the literature1 3 and an incidence of 0.4–1.5% in previous angiographic studies of cases of ischemic cerebrovascular disease;2 4 however, this may be an underestimation of the disease. Ruptured plaques at the carotid bifurcation are more common causes of acute ischemic stroke.…”

Free Floating Carotid Artery Thrombosis: Case Report

“…arter trombüsü tedavisinde, medikal ya da cerrahi tedavi uygulanabilmektedir, fakat sıklıkla hastalar operasyona gereksinim duymaktadır. [1][2][3] Medikal tedavide düşük molekül ağırlıklı heparini (enoksaparin) ya da intravenöz heparini takiben warfarin uygulanmaktadır. 1,3 Cerrahi tedavi seçenekleri arasında; karotis artere stent yerleştirilmesi, karotis arterin baypas edilmesi ve karotis arter endarterektomi yer almaktadır.…”