Why the study?
Aortic arch thrombus is a rare condition capable of catastrophic sequelae, warranting discussion of its predisposing factors, radiologic findings, and management strategies.
Anticoagulation with direct oral anticoagulants (DOACs) such as rivaroxaban can be an effective and safe treatment modality for floating aortic arch thrombus when surgical intervention is unfeasible.
Answers are grounded in this paper and cite their sources.
May offer a medical option when surgery is unfeasible; leaves open comparative outcomes and duration for isolated floating aortic-arch thrombus.
Aortic arch thrombus is a rare entity that can result in catastrophic sequelae. This is a case report of a 65-year-old female patient who presented with chest pain that started one day prior to arrival at the emergency department. Acute coronary syndrome (ACS) and pulmonary embolism (PE) were ruled out. A filling defect at the distal aortic arch evident on chest computed tomography angiography (CTA) was confirmed to be a floating distal aortic arch thrombus on transesophageal echocardiogram (TEE). There was no evidence of an underlying aneurysm, dissection, or significant atherosclerosis. The patient was considered to be at high risk for surgical intervention, hence, a decision was made to start the patient on chronic anticoagulation with direct oral anticoagulants (DOACs). A follow-up CTA three months later showed total resolution of the thrombus. The report highlights this treacherous pathology and provides an overview of the predisposing factors, radiologic findings, as well as management strategies for floating aortic arch thrombi.
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Ghoweba et al. (2022) studied this question.
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