A Case of Sub-occlusive Free-Floating Thrombus in the Basilar Artery Causing Stroke-Like Symptoms: A Case Report.

Free‑floating thrombus (FFT) - also known as intraluminal thrombus - refers to a clot that remains partially adherent to the vessel wall yet projects into the lumen, permitting movement with the bloodstream. Since its attachment is tenuous, the thrombus carries a heightened risk of fragmentation, embolization, or partial obstruction of blood flow, thereby significantly increasing the likelihood of developing a transient ischemic attack or ischemic stroke. The patient may exhibit motor, sensory, and/or cortical symptoms. Regardless of the severity, immediate intervention can lead to a complete neurological recovery. In this case report, we present the scenario of a 28-year-old female patient with symptomatic sub-occlusive basilar artery thrombus, who developed stroke-like symptoms, subsequently undergoing multiple investigations and interventions, including thrombolysis and thrombectomy. Identifying a sub‑occlusive basilar artery thrombus in a patient exhibiting classic stroke symptoms, but without any ischemic changes evident on imaging, is considered highly unusual and represents a rare diagnostic challenge. This case reveals that FFT should be considered in the differential diagnosis of patients presenting with acute neurological symptoms, even in the absence of typical ischemic changes on initial imaging. Early diagnosis and aggressive management with high-dose dual antiplatelet therapy (Aspirin 300 mg and Clopidogrel 300 mg as loading doses) in addition to thrombolysis and mechanical thrombectomy can lead to favorable outcomes. This case highlights the value of a multidisciplinary strategy and underscores the urgent need for further research to clarify the pathophysiology and optimize management of FFT.