Khattab Hajar, Khalfi Manal, Haddouali Kamal, Sikkal Asmae, Bellakhdar Salma, El Otmani Hicham, El Moutawakil Bouchra, Abdoh Rafai Mohammed
Department of Neurology, Ibn Rochd University Hospital, Casablanca, MAR.
Department of Neurology, Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Casablanca, MAR.
Cureus. 2025 Jul 31;17(7):e89156. doi: 10.7759/cureus.89156. eCollection 2025 Jul.
Free-floating thrombus (FFT) is a rare but clinically significant vascular finding, not only in ischemic stroke but also in other contexts such as routine imaging for asymptomatic patients or evaluation of other vascular diseases. It is characterized by an intraluminal thrombus adherent to the arterial wall with partial luminal occlusion and cyclic movement synchronized with the cardiac cycle. Although associated with an increased risk of embolic complications, including recurrence, no consensus exists regarding optimal management. This study aims to describe the clinical and radiological characteristics of FFTs in a hospital-based case series and to report treatment strategies and outcomes.
A retrospective study was conducted over a 17-month period (2023-2024) at Ibn Rochd University Hospital, including patients with acute ischemic stroke and FFT diagnosed via computed tomography angiography (CTA) and/or duplex ultrasound (DUS). Collected data included age, NIHSS score at admission, etiological workup, and both clinical and imaging outcomes. Therapeutic management was guided by stroke severity, hemorrhagic risk, availability of treatment modalities, and the results of the etiological workup.
Among 940 ischemic stroke cases, FFT was identified in eight patients (0.8%), with a mean age of 50.6 years. Atherosclerosis was the predominant etiology. The thrombus was most frequently localized in the carotid arteries, but also involved the brachiocephalic and vertebral arteries. No patients received intravenous thrombolysis due to concerns regarding embolization risk. Medical management was applied in all cases, with six patients receiving anticoagulation therapy, and five of them receiving combined antiplatelet therapy and statins. One patient underwent delayed carotid endarterectomy following stroke recurrence. At three months, thrombus resolution was complete in four cases, while the remaining patients exhibited partial regression.
FFT represents a high-risk entity for stroke recurrence, requiring individualized management. In our limited case series, medical management (primarily anticoagulation, sometimes combined with antiplatelet therapy) was observed to be associated with thrombus resolution in most patients. Delayed surgical or endovascular intervention may be considered in cases of persistent thrombus or recurrence. These observations should be interpreted with caution. Larger prospective studies are needed to define optimal management strategies and clarify the role of endovascular interventions.
漂浮血栓（FFT）是一种罕见但具有临床意义的血管表现，不仅在缺血性卒中中可见，在其他情况下也可出现，如无症状患者的常规影像学检查或其他血管疾病的评估。其特征为腔内血栓附着于动脉壁，伴有部分管腔闭塞，并与心动周期同步进行周期性移动。尽管FFT与包括复发在内的栓塞并发症风险增加相关，但关于最佳治疗方案尚无共识。本研究旨在描述基于医院的病例系列中FFT的临床和影像学特征，并报告治疗策略及结果。
在伊本·罗奇德大学医院进行了一项为期17个月（2023 - 2024年）的回顾性研究，纳入通过计算机断层扫描血管造影（CTA）和/或双功超声（DUS）诊断为急性缺血性卒中和FFT的患者。收集的数据包括年龄、入院时的美国国立卫生研究院卒中量表（NIHSS）评分、病因学检查以及临床和影像学结果。治疗管理依据卒中严重程度、出血风险、可用的治疗方式以及病因学检查结果进行指导。
在940例缺血性卒中病例中，8例（0.8%）患者被诊断为FFT，平均年龄为50.6岁。动脉粥样硬化是主要病因。血栓最常位于颈动脉，但也累及头臂动脉和椎动脉。由于担心栓塞风险，无一例患者接受静脉溶栓治疗。所有病例均采用药物治疗，6例患者接受抗凝治疗，其中5例同时接受抗血小板治疗和他汀类药物治疗。1例患者在卒中复发后接受了延迟颈动脉内膜切除术。三个月时，4例患者的血栓完全溶解，其余患者血栓部分消退。
FFT是卒中复发的高危因素，需要个体化管理。在我们有限的病例系列中，观察到大多数患者通过药物治疗（主要是抗凝治疗，有时联合抗血小板治疗）可使血栓溶解。对于持续存在血栓或复发的病例，可考虑延迟进行手术或血管内介入治疗。这些观察结果应谨慎解读。需要开展更大规模的前瞻性研究来确定最佳治疗策略，并阐明血管内介入治疗的作用。
