Diagnosis and Surgical Management of Free-Floating Thrombus Within the Carotid Artery

• Published in: Vascular and endovascular surgery Vol. 44; no. 7; pp. 586 - 593
• Main Authors: Lane, Tristan R. A., Shalhoub, Joseph, Perera, Ryan, Mehta, Amrish, Ellis, Mary R., Sandison, Ann, Davies, Alun H., Franklin, Ian J.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-10-2010; Sage Publications
• Subjects: Adult; Aged; Biological and medical sciences; Carotid Artery Thrombosis - complications; Carotid Artery Thrombosis - diagnostic imaging; Carotid Artery Thrombosis - surgery; Carotid Stenosis - complications; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - surgery; Cerebral Angiography - methods; Diffusion Magnetic Resonance Imaging; Endarterectomy, Carotid; Female; Humans; Infarction, Middle Cerebral Artery - etiology; Infarction, Middle Cerebral Artery - pathology; Male; Medical sciences; Middle Aged; Neurology; Predictive Value of Tests; Prospective Studies; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Duplex; Vascular diseases and vascular malformations of the nervous system; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Young Adult; free-floating; thrombus; carotid; vascular; surgery; Arterial disease; Vascular disease; Clinical management; Carotid; Surgery; Cardiovascular disease; Diagnosis; Artery thrombosis
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/1538574410375312

Objective: Free-floating thrombus (FFT) of the carotid artery is a rare condition of currently unknown etiology. Less than 150 cases have been described in the published world literature to date. Design and Setting: We present 6 consecutive cases of carotid FFT, identified prospectively from 5000 carotid duplex scans over a 34-month period in a single tertiary center for vascular surgery. Results: All 6 cases involved the left carotid bifurcation in neurologically symptomatic individuals. In 5 of the 6 cases, FFT occurred in the absence of a significantly stenosing atheromatous plaque and was not associated with an elevation in velocity on duplex. The patients were all treated with surgical thromboendarterectomy, with good result. Conclusions: Duplex imaging can underestimate the degree of stenosis. Free-floating thrombus presents a challenge in diagnosis due to its rapidly evolving nature. The management of FFT by acute thromboendarterectomy appears to be safe and effective in limiting further focal neurological sequelae.