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Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1269--1270

Free-Floating Thrombus in the Carotid Artery Without Atherosclerosis Dissolved by Antithrombotic Therapy

Eri Shiozaki, Yoichi Morofuji, Ichiro Kawahara, Keisuke Tsutsumi 
 Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan

Correspondence Address:
Yoichi Morofuji
Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki - 856-8562
Japan




How to cite this article:
Shiozaki E, Morofuji Y, Kawahara I, Tsutsumi K. Free-Floating Thrombus in the Carotid Artery Without Atherosclerosis Dissolved by Antithrombotic Therapy.Neurol India 2021;69:1269-1270


How to cite this URL:
Shiozaki E, Morofuji Y, Kawahara I, Tsutsumi K. Free-Floating Thrombus in the Carotid Artery Without Atherosclerosis Dissolved by Antithrombotic Therapy. Neurol India [serial online] 2021 [cited 2022 Jan 27 ];69:1269-1270
Available from: https://www.neurologyindia.com/text.asp?2021/69/5/1269/329578


Full Text



 Clinical Images



A 68-year-old man presented with sudden right upper limb weakness. Once the symptom improved, it reappeared on the same day. Magnetic resonance imaging showed acute small cerebral infarction in the left watershed area. The carotid ultrasonography demonstrated free-floating thrombus (FFT) in the proximal left internal carotid artery (ICA). The thrombus was about 3 cm long and had mobility. Computed tomography angiography (CTA) showed filling defect in the left ICA. There was no atherosclerosis in the ICA, and the biochemical investigation showed no hypercoagulable states. We started on antithrombotic therapy and planned for thromboendarterectomy (TEA). However, the ultrasonography on the 11th day demonstrated extreme diminish of the FFT, and only the residual root of the thrombus was detected. The FFT disappeared completely on the 17th day and did not have recurrence for 6 months [Figure 1].{Figure 1}

There is no consensus on the treatment for FFT. Some have reported the favorable outcomes of acute TEA or carotid stenting for FFT,[1],[2] but the morbidity of surgical or interventional treatment for FFT is higher than that for the usual atherosclerotic plaque. Anticoagulated therapy has been reported to be effective to dissolve FFT, although most FFT are related to atherosclerotic stenosis and require delayed surgical treatment.[3],[4] In the present case, FFT was attached to the ICA without any plaque. We suspect that the undetectable endothelium injury or subsequent inflammation process might have caused FFT, and we continued antiplatelet therapy after FFT dissolved.

In conclusion, FFT can be dissolved by medical management alone and not all FFT need surgical treatment in the acute phase.

Authors' contributions

Conception and Design: Shiozaki, Morofuji. Acquisition of data: Shiozaki. Drafting the article: Shiozaki, Morofuji. Critically revising the article: all authors.

Acknowledgments

We wish to thank Yuka Ogawa, Takehiro Ito, Kazuya Honda, Tomonori Ono, and Wataru Haraguchi for providing insight and expertise to assist this article.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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