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Abstract
Introduction Floating thrombus in the aortic arch (FTAA) is a rare condition, potential source of systemic embolisms, mostly associated with age, atherosclerosis or hypercoagulable conditions.
Arterio-arterial embolism to the supra-aortic trunks is the most feared complication of the FTAA, rarely documented and with no univocal treatment guidelines.
It is unusual to detect it in young subjects without other comorbidities as in our case.
Case Description A man in his 40s with right hemisyndrome came to our attention.
The Contrast-enhanced CT (CECT) highlighted an irregular thrombotic formation floating into the lumen of the aortic arch (figure 1). The patient immediately underwent antithrombotic therapy.
Few hours later, we incidentally documented the asymptomatic displacement of part of the thrombus into the left ICA lumen with a filiform prolongation extended to the intracranial entrance (figure 2).
The endovascular approach with the aim of thromboaspiration was considered, but it implied the risk of distal mobilization of the ICA thrombotic component.
Furthermore, the thrombus was morphologically elongated, raising issues about device choice in the stenting option.
We opted for conservative treatment with medical therapy and continuous monitoring.
On 17th day, considering the CECT evidence of progressive lysis of the thrombotic formations (figure 3) and the clinical stability (NIHSS 4), discharge and follow-up were decided, continuing with medical therapy (LMWH, an oral anticoagulant and ASA).
Results We highlighted the main operational risks, the technical difficulties and the specific features of the case which lead us to opt for a conservative approach, achieving positive results.
Disclosure of Interest no.