Diagnosis and surgical management of free-floating thrombus within the carotid artery.
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.


METHODS
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.
Lane
Tristan R A
TR
Department of Vascular Surgery, Charing Cross Hospital, Imperial College NHS Trust, Imperial College London, London, UK.
Shalhoub
Joseph
J
Perera
Ryan
R
Mehta
Amrish
A
Ellis
Mary R
MR
Sandison
Ann
A
Davies
Alun H
AH
Franklin
Ian J
IJ
D000328:Adult; D000368:Aged; D002341:Carotid Artery Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex; D055815:Young Adult