Stentriever thrombectomy with distal protection device for carotid free floating thrombus: a technical case report

Abstract

We report the clinical details, imaging findings and management of a 45-year-old man who presented with recurrent transient ischemic attacks due to carotid free floating thrombus. Free floating thrombus of the carotid artery is a very rare condition with a high risk of distal embolic shower. The optimal treatment options are debatable and include medical management, surgical thrombectomy and endovascular thrombectomy. We describe the use of a stentriever with filter protection in the management of carotid free floating thrombus as a novel treatment option.

Expanding the role of stent-retriever endovascular thrombectomy: a case series of free-floating thrombus

“…Previously described endovascular procedures include carotid angioplasty and stenting,16 with EVT reserved for acute ischaemic stroke 2. However, increasing procedural experience and evolution of techniques has established EVT as a potentially effective intervention, with successful case reports described 14. Our cases further highlight the potential for stent retriever EVT in the management of carotid artery FFT, notably in both acute and subacute presentations.…”

“…EVT also offers certain advantages over surgery: shorter procedure time and minimal vascular manipulation, while still affording the opportunity for en bloc elimination of the thrombus 14. General anaesthesia is not required and anticoagulation may be continued in the periprocedural period if necessary.…”

Carotid Stenting as Definitive Treatment for Free Floating Thrombus—Review of 7 Cases

“…Surgical treatment offers the potential advantage of a definitive treatment for the FFT via embolectomy and also the underlying pathology via endarterectomy in cases of atherosclerosis. Endovascular treatment options have more recently been shown to be effective in the management of FFT [13][14][15]. Potential advantages of the endovascular approach compared to the standard vascular surgical approach include shorter procedure times with minimal vascular manipulation, which has the potential for dislodging the FFT, but still having the potential to cover the FFT en bloc.…”

“…Mechanical thrombectomy, using either aspiration or stent-retrievers, can also be performed and several cases have been published [13,15,18]. In the small series (n = 3) presented by Fitzpatrick et al [15] the authors used a combined approach with proximal balloon protection, distal protection with a filter wire, and stent-retriever mechanical thrombectomy.…”

“…Using this technique the authors successfully retrieved all the clots, with no migration into the intracranial circulation with a maximum of two passes. Giragani et al [13] described a similar approach, combining a distal filter wire and stent-retriever. In this case, despite medical treatment with antiplatelets and anticoagulants, the patient continued to have TIA and therefore, a more definite option was considered.…”