ABSTRACT NUMBER: ESOC2026A2186 TREATMENT OUTCOMES OF ACUTE STROKES WITH FREE FLOATING THROMBUS:EXPERIENCE FROM A NORTH INDIAN STROKE CENTER

Abstract Background and aims Free floating thrombi(FFT) are an uncommon but significant finding on vascular imaging in Stroke patients. There is no consensus on its optimal management with thrombolysis being considered risky. We describe a single center experience of acute ischemic strokes(AIS) with FFT. We aimed to determine the clinical and imaging outcomes of AIS with FFT. Methods Restrospective data(01-1-2022 to 05-01-2026)from acute stroke registry of our center was analysed for AIS presenting within 24 hours of onset with FFT on vascular imaging.Clinical details,demographics and 3 month clinical (modified Rankin Scale) and imaging outcomes were recorded. Results Out of 1069 AIS patients, 12(1.12%) were detected with FFT.Mean age was 43.75+/-12.29,males 92%(11). 58% were smokers,17% hypertensives and 8% Diabetics. Median NIHSS at admission was 14(11,17). 92%(11) had FFT in Internal Carotid while 1 in the vertebral artery. Acute intervention was carried out in 5 (42%); Thrombectomy in 1,IV thrombolysis in 4 patients,1 refused treatment and 5 were given medical management.At 3 months, Median NIHSS was 7, mRS 2 with 42% patients having mRS 0-2. 3 months Median mRS in thrombolysed patients was 2 and 5 in thrombectomy patient . There was no worsening or stroke recurrence observed. Conclusions Incident FFT are uncommon ( ~1.2%). Management with IV thrombolysis appears to be safe and associated with good clinical outcomes. Efficacy of thrombolysis in FFT needs to be confirmed in a clinical trial. Conflict of interest Nothing to disclose