Endovascular treatment of asymptomatic free-floating thrombus in the carotid artery bifurcation: a direct aspiration first-pass technique under double balloon protection

• Published in: BMJ case reports Vol. 12; no. 8; p. e230295
• Main Authors: Yamaoka, Ayumu, Miyata, Kei, Iihoshi, Satoshi, Mikuni, Nobuhiro
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.08.2019; BMJ Publishing Group
• Series: Case Report
• Subjects: Aged; Arm - blood supply; Arm - surgery; Balloon Occlusion - methods; Blood clots; Carotid arteries; Carotid Arteries - surgery; Case reports; Catheters; Embolisms; Endovascular Procedures - methods; Female; Humans; Medical imaging; Neurosurgery; Novel Treatment (New Drug/Intervention; Established Drug/Procedure in New Situation); Reperfusion - instrumentation; Reperfusion - methods; Stents; Stroke; Thrombosis - therapy; Veins & arteries; United States > US; neurosurgery; stroke; radiology
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2019-230295

Free-floating thrombus (FFT) in the carotid artery has been reported as a rare cause of acute ischaemic stroke. There are various treatment strategies, but higher risk of distal embolism may limit their applicability. A 77-year-old woman noticed right upper arm weakness. A CT angiogram revealed that a large floating thrombus had strayed across the carotid bifurcation, while another thrombus was present in the right axillary artery. As for the carotid FFT, in spite of anticoagulation therapy, the number of asymptomatic microthrombuses gradually increased on diffusion-weighted MRI. We performed endovascular therapy utilising two temporary occlusion balloon catheters and performed direct aspiration with a reperfusion catheter. The procedure was uneventful. We successfully performed a new endovascular technique for FFT in the carotid bifurcation. Our method is effective, minimally invasive and safe.