Evolution of the management of symptomatic carotid artery stenosis with free floating thrombus

Free floating carotid thrombus (FFCT) is an infrequent but dangerous finding of symptomatic carotid stenosis. Definitive management for FFCT is not well defined and the risk of stroke after endarterectomy comes with almost a threefold increase in stroke risk. Initial anticoagulation will usually resolve the thrombus on its own and allow for traditional management. In those that persist, there remains a low chance of recurrent stroke at 30 days with continued anticoagulation. For patients who have persistent disease, or recurrent symptoms, Transcarotid Artery Revascularization (TCAR) with Percutaneous Mechanical Thrombectomy (PMT) appears to be a safer alternative option to Carotid Endarterectomy.