Background Free floating thrombi of the common carotid artery are rare causes of acute stroke syndromes. In previously described cases, authors have either advocated surgical management or conservative anticoagulation therapy. We described two cases in which endovascular management provided definitive and longstanding treatment.

Case 1 A 51-year-old Hispanic woman with a history of insulin dependent diabetes mellitus (IDDM), hypertension and hyperlipidemia presented with 2–3 days of waxing and waning right sided hemiparesis, aphasia and paresthesia. Initial non-contrast-enhanced head computed tomography (NECT) examination demonstrated no evidence of acute intracranial pathology. Doppler sonogram and cervical angiogram confirmed the presence of the thrombus with 70–80% stenosis. CT angiogram of the brain vasculature demonstrated no evidence of intracranial large vessel occlusion. Brain Magnetic Resonance Imaging (MRI) demonstrated acute watershed infarcts in the left cerebral hemisphere as well as a few punctate embolic infarcts. Serologic workup was significant only for hyperglycemia. After a brief course of heparinization, successful mechanical revascularization was accomplished using direct aspiration of the thrombus.

Case 2 A 51-year-old African American male with a history of insulin dependent diabetes mellitus and hyperlipidemia presented emergently after 6 hours of acute aphasia and right sided hemiparesis. Initial NECT demonstrated left middle cerebral artery (MCA) territory infarcts involving the frontal and temporal lobes. Cervical CT Angiogram demonstrated a long segment free floating thrombus of the distal left common carotid artery (CCA), which was confirmed on subsequent cervical angiogram. In this case, mechanical revascularization was accomplished with aspiration and stentretriever, followed by balloon angioplasty.

Conclusion Endovascular mechanical revascularization is an efficient and definitive treatment in patients with free floating carotid thrombi.

Disclosures K. Carr: None. Z. Thwing: None. R. Shivashakar: None. Y. Serulle: None.