ABSTRACT NUMBER: ESOC2026A1616 FREE FLOATING THROMBUS : THERAPEUTIC CHALLENGES AND OUTCOMES - A FRENCH RETROSPECTIVE STUDY

Abstract Background and aims Despite advances in stroke care, there is no consensus on managing free-floating thrombi (FFT) in patients with acute ischemic stroke or TIA. Furthermore, treatment in current practice is increasingly complex, particularly regarding anticoagulation with or without antiplatelet therapy considering the bleeding risk. This single-center retrospective study aims to describe current FFT management and outcomes. Methods We searched in our hospital electronic datawarehouse by text-mining process for references reporting FFT in imaging reports from 2004 until June 2023. Frequency, treatment strategies and outcomes were assesed. Surgical timing was defined as early (<72h) or delayed (≥72 h). Results We identified 147 patients with stroke and/or TIA in a French comprehensive stroke center. The main source of emboli was atheromatous plaque (98 ; 66.7%) followed by thrombophilia (14 ; 9.5%). Anticoagulation alone was initiated in 53 patients (36.4%), dual antiplatelet therapy in 65 patients (44.2%) and combined therapy in 22 patients (14.9%). Over a median follow-up of 14 days, overall FFT resolution rate was 77.6% occuring earlier and more frequently with anticoagulation alone than with dual antiplatelets therapy (90.6% vs. 67.7%, P < 0.001). No major bleeding events occured with no difference in brain thromboembolism (12 ; 8.8% P = 0.465). Patients who received anticoagulation alone or in adding had better functional prognosis (P = 0.004). Conclusions In a real-world setting, this study suggests improved thrombus resolution in patients treated with anticoagulation with lower risk of secondary embolism. However, patients at high hemorrhagic risk may have been managed conservatively. Thus, Randomized trials are required to answer this question. Conflict of interest Nothing to disclose