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Case Reports
. 2022 Sep;43(9):5629-5632.
doi: 10.1007/s10072-022-06156-y. Epub 2022 May 21.

Floating aortic arch thrombus involving the left common carotid artery complicated with ischemic stroke associated with cocaine use

Moussa Toudou-Daouda  1 , Gary Ouanounou  2 , Manvel Aghasaryan  2 , Nana-Rahamatou Aminou-Tassiou  2 , Djibril Soumah  2 , Leila Bentamra  2 , Léonard Smadja  2 , Tony Altarcha  2 , Nicolas Chausson  2 , Didier Smadja  2
Affiliations
Case Reports

Floating aortic arch thrombus involving the left common carotid artery complicated with ischemic stroke associated with cocaine use

Moussa Toudou-Daouda et al. Neurol Sci. 2022 Sep.

Abstract

Background: Floating aortic thrombi (FLOAT) are rare, with very few cases attributed to cocaine use. We report a new case of FLOAT involving the left common carotid artery due to cocaine use, for the first time, complicated with acute ischemic stroke.

Methods: We present in detail our case report, and then, a literature search in PubMed and Scopus was performed up to March 20, 2022, to review the reported cases of aortic thrombus associated with cocaine use.

Results: A 39-year-old man with a history of smoking and daily cocaine use was admitted to our stroke unit for acute left-hemispheric symptoms due to carotid-Sylvian occlusion. CT angiography of the supra-aortic trunks showed FLOAT involving the left common carotid artery. The thrombus was removed successfully by endovascular thrombectomy with recanalization of carotid-Sylvian occlusion. Our literature search yielded seven reported cases of aortic thrombus due to cocaine use revealed by lower limb ischemia (3 patients), renal infarction (1 patient), abdominal pain (1 patient), bowel ischemia (1 patient), and lower limb ischemia with renal infarction (1 patient).

Conclusion: Aortic thrombus should be suspected in patients without overt cardiovascular risk factors but with a recent history of cocaine use who presents with acute ischemic stroke.

Keywords: Aorta; Cocaine use; Floating thrombus; Ischemic stroke.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
a, b Diffusion-weighted MR showing ischemic stroke of left middle cerebral artery territory. c, d, e Fluid-attenuated inversion recovery showing slow flows in the left hemispheric sulci with slight visibility of ischemic stroke on the lenticular caudate. f Time-of-flight MR angiography showing left carotid-Sylvian occlusion. g, h CT angiography showing floating aortic arch thrombus involving the left common carotid artery
See this image and copyright information in PMC

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