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. 2023 Nov 22;12(23):7238.
doi: 10.3390/jcm12237238.

Symptomatic Carotid Free-Floating Thrombus: About Management of 50 Cases in a Referral Neurovascular Center

Sarah El Harake  1   2 , Emilie Doche  3 , Julien Bertolino  1 , Nadia Laksiri  3 , Michel Alain Bartoli  4 , Barbara Leclercq  1   2 , Laurent Suissa  3 , Gabrielle Sarlon-Bartoli  1   2
Affiliations

Symptomatic Carotid Free-Floating Thrombus: About Management of 50 Cases in a Referral Neurovascular Center

Sarah El Harake et al. J Clin Med. .

Abstract

Background: Carotid free-floating thrombus (CFFT) is an uncommon disorder. The aim of this study was to describe a French cohort of CFFT patients.

Methods: We conducted a retrospective monocentric study from a Stroke Center among patients admitted for stroke with CFFT.

Results: Between January 2017 to December 2019, 2038 ischemic strokes were recorded. A total of 50 patients with CFFT were consecutively included (32 men/18 women). The mean age was 58.2 years (±11.7). Their etiologies were atheroma (46%), carotid dissection and web (20%), hypercoagulability disorders (16%) and arrhythmia (10%). Exclusive medical management was performed in 38 patients (76%): 29 (59.2%) were anticoagulated and 9 (18.4%) received antiplatelets alone in the first week. Surgical intervention was performed in the first 30 days for 11 patients (22%). The main surgical indication was a residual carotid stenosis over 70%. Only three patients had a recurrent stroke in the medical group with anticoagulants. No patients in the antiplatelet group or the surgical group had a recurrent stroke.

Conclusions: Our study summarized a large cohort of 50 patients with CFFT. This diagnosis implies the need to search for a local arterial disease and to screen for hypercoagulability states. An initial medical strategy followed by a delayed carotid surgery if the follow-up imaging shows a residual stenosis appears to be safe.

Keywords: atheroma; carotid; free-floating thrombus; hypercoagulability.

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Conflict of interest statement

The authors declare no conflict of interest.

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