Rapid Resolution of Newly Formed Carotid Free-Floating Thrombus Through Anticoagulation Therapy

Background Carotid free-floating thrombus (CFFT) are rare but carry significant risks of ischemic strokes. While the predominant treatment modality typically involves vascular intervention, in this case study, we highlight the feasibility of alternative options, specifically short-term anticoagulation therapy guided by extensive radiological evaluation. Case presentation: We admitted a patient with acute ischemic stroke due to middle cerebral artery (MCA) occlusion, and the National Institutes of Health Stroke Score (NIHSS) was 15. The patient was satisfactorily revascularized by prompt intravenous alteplase thrombolysis, but a rare occurrence of carotid free-floating thrombus was found, which was the culprit for the occlusion of the MCA. Instead of surgical treatment, we performed extensive radiological evaluations for the thrombus, including high-resolution magnetic resonance and serial ultrasonic scans. The intramural thrombus is highly suspected to be newly formed, so we hypothesized it might respond to anticoagulant therapy. As expected, after short-term anticoagulant therapy of enoxaparin injection, CFFT significantly dissolved. Conclusions This case illustrates the efficacy of anticoagulation for newly formed CFFT and introduces a novel treatment protocol guided by extensive radiological evaluation.