Management of free-floating thrombus within the arcus aorta and supra-aortic arteries.

INTRODUCTION: Clinical management strategy and the best treatment option of free floating thrombus (FFT), detected in patients with acute ischemic cerebrovascular diseases is still uncertain due to the rarity of these conditions. Recent studies emphasize that FFT within cerebral vessels may not be a surgical emergency since complete dissolution without any further neurologic progression occurred in 86% of patients treated medically. The aim of this study was to investigate the effect of medical treatment on the fate of thrombus and the clinical status in acute cerebrovascular event patients with detected FFT in the artery feeding the compromised brain territory at the time of diagnosis.

MATERIALS AND METHODS: We have retrospectively reviewed the initial and follow up computed tomography angiography, diffusion-weighted magnetic resonance imaging examinations of 37 acute ischemic stroke patients with detected FFT and treated medically. The patients were evaluated for any change of the FFT, residual stenosis after the FFT shrunk or disappeared and neurologic outcome.

RESULTS: FFT was located in cervical carotid artery, intracranial artery and arcus aorta in 23, 6 and 5 of the patients respectively. Dissection accompanied the FFT in 3 patients. Recanalization was maintained in 34 patients however, three of them suffered from new infarctions. A total occlusion was detected in three patients. Two of them had new infarcts while one was stable during clinical follow-up period.

CONCLUSION: The results of our retrospective study have shown that FFT in the proximal aorta and supra-aortic arteries tend to resolve with anticoagulant and/or antiplatelet treatment without causing recurrent adverse events in most of the cases. Furthermore, resolution of the clot seems to provide a safer ground for a recanalization procedure like stenting or endarterectomy if needed.