# Floating Thrombus as an Underdiagnosed Etiology for Stroke: A Case Series

## TL;DR

Floating thrombus in neck and head arteries is a rare but underdiagnosed cause of stroke, with varied causes and treatment approaches.

## Contribution

This case series highlights the underdiagnosed nature of floating thrombus as a cause of stroke and its varied clinical and radiological features.

## Key findings

- FFT occurred in the aortic arch and carotid bifurcation in patients with ischemic stroke.
- Two patients underwent thrombolysis without deterioration, and all showed thrombus reduction with neurological improvement.
- FFT is underrecognized, and larger studies are needed to establish treatment guidelines.

## Abstract

Free-floating thrombus or intraluminal thrombus (FFT/ILT) of the cervicocephalic arteries is an important but underrecognized cause of ischemic stroke with high embolic risk. Here, we describe the varied clinical, radiological, etiological, and management strategies in patients with FFT. Five patients with acute ischemic stroke and FFT in the cervicocephalic arteries were identified by computed tomography angiography after excluding other causes. The patients received individualized treatment, with follow-up imaging and clinical evaluation. FFT occurred in the aortic arch and carotid bifurcation. Etiologies included atherosclerosis and prothrombotic states such as systemic lupus erythematosus. Two patients underwent thrombolysis without deterioration. All received antithrombotic therapy and statins, showing thrombus resolution or reduction with neurological improvement. FFT is an emerging, underrecognized cause of stroke. Early imaging diagnosis and individualized treatment yielded favorable outcomes, but established guidelines are still lacking, highlighting the need for larger studies.