Symptomatic Common Carotid Free-Floating Thrombus in a COVID-19 Patient, Case Report and Literature Review

Abstract

Carotid free-floating thrombus is an uncommon entity that usually presents with neurologic symptoms. Crescendo transient ischemic attack is an accepted indication for urgent carotid endarterectomy. COVID-19 is associated with severe thromboembolic complications. We report the case of a 61-year-old man who developed, 2 weeks after the diagnosis of COVID-19, crescendo transient ischemic attack, complicating a large intraluminal floating thrombus within the right common carotid artery. A carotid thromboendarterectomy under local anesthesia, with patch closure was immediately performed without complications. We conducted a literature review to identify cases of common carotid artery thrombus related to COVID-19. Carotid free-floating thrombus in the common carotid artery is exceptional. However, since the beginning of the COVID-19 pandemic, 15 cases have been published.

Keywords: COVID-19; Carotid free-floating thrombus; Crescendo transient ischemic attack; carotid endarterectomy; organized thrombus.

Fig 1

Axial (A and B) and sagittal (C) images of neck computed tomography angiography reveals a thrombus in the right CCA extending into carotid bifurcation. Image A: Thrombus with surrounding blood flow at its distal end. Image B: Thrombus attached to the wall.

Fig 2

Intraoperative duplex ultrasound shows the mobile distal end of thrombus near carotid bifurcation and nearly occlusion of the right common carotid artery.

Fig 3

Intraoperative image showing an organized nearly occlusive thrombus (white arrow), which was partially attached to a small atherosclerotic plaque (black arrow).