Key result
Conservative medical management with anticoagulation and antiplatelet therapy resulted in complete spontaneous resolution of carotid stenosis and free floating thrombus within 14 to 24 days.
Why the study?
Does conservative medical management resolve free floating thrombus in patients with symptomatic carotid stenosis?
Case Report (n=2)
No
Does conservative medical management resolve free floating thrombus in patients with symptomatic carotid stenosis?
Conservative medical management with anticoagulation and antiplatelet therapy can lead to rapid and complete resolution of free floating thrombus in symptomatic carotid stenosis.
These cases highlight diagnostic vigilance in acute stroke; leaves open optimal management strategies for carotid free-floating thrombus.
Free floating thrombus is uncommon in the carotid arteries, and it is defined as an elongated thrombus attached to the arterial wall with circumferential blood flow at its distal most aspect. The majority of patients present with acute neurological deficits and usually have an underlying unstable atherosclerotic plaque. We present two cases of carotid stenosis associated with free floating thrombus. Both patients shared similar clinical presentation and were managed according to the standard workflow for suspected ischemic strokes from our institution. Conservative management was decided based on a multidisciplinary decision that intervention of any kind would be associated with high risk of periprocedural complications. Complete resolution of the atherosclerotic plaque and free floating thrombus in a short period occurred. We further discuss the mechanism behind such a dramatic radiographic and clinical improvement with medical therapy, hypothesizing that plaque erosion is a plausible explanation, based on pathology studies.
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Monteiro et al. (2020) conducted a case report in Carotid stenosis with free floating thrombus (n=2). Conservative medical management (anticoagulation and antiplatelet therapy) was evaluated on Radiographic resolution of intraluminal thrombus and carotid plaque. Conservative medical management with anticoagulation and antiplatelet therapy resulted in complete spontaneous resolution of carotid stenosis and free floating thrombus within 14 to 24 days.
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