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

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.