Free-floating thrombus of the internal carotid artery

Free-floating thrombus of the internal carotid artery is an uncommon entity placing the patient at high risk for acute ischemic stroke. It is characterized by intraluminal thrombus within the internal carotid artery (ICA) and aggressively managed with surgical, medical, or combined therapy.

Epidemiology

The true incidence is unknown. Estimates range from 0.05% to 0.7%.

Clinical presentation

The majority of patients present with acute neurological symptoms concerning for stroke or transient ischemic attack.

Radiographic features

Intraluminal thrombus projecting into the internal carotid artery. It is frequently associated with atherosclerotic plaque. The amount of thrombus can range from a small to extensive throughout the ICA.

Treatment and prognosis

Aggressive management with urgent endarterectomy, anticoagulation, or combined medical/surgical approaches has all shown success .