Formation of a carotid free-floating thrombus (CFFT) is a rare and life-threatening condition without an optimal management plan. A 78-year-old woman with a history of prior right internal carotid artery (ICA) mechanical thrombectomy and antiplatelet noncompliance presented with transient ischemic attacks secondary to a recurrent CFFT in the right ICA. Given her symptoms and recurrent CFFT, endovascular mechanical thrombectomy was performed. A balloon guide-catheter (BGC) and a Zoom 88 distal access catheter were brought into the right distal common carotid artery and proximal ICA bulb, respectively. Three 0.021-inch microcatheters, each loaded with a unique stentriever, were navigated beyond the thrombus into the upper cervical ICA and deployed in a bouquet fashion. The BGC was inflated to achieve flow arrest, and the Zoom 88 aspiration catheter was tracked over the three bouquet stentrievers to ingest the thrombus. Follow-up angiography demonstrated recanalization of the proximal cervical ICA without evidence of residual thrombus. Twenty-four-hour postoperative computed tomography imaging did not reveal any evidence of new infarction. The patient was discharged home with an intact neurological examination, compliant on aspirin and apixaban. We demonstrate a novel technique utilizing a large-bore catheter with a triple stentriever “bouquet” to thrombectomize a CFFT.

This material was accepted as an e-poster at the 2023 Annual Society of NeuroInterventional Surgery meeting in San Diego, California, United States.

J.K.C., B.M.M., M.W.K., J.C.C.d.B. assisted with the conception and design of the manuscript. J.K.C., B.M.M., and D.A.Z. drafted and revised the manuscript for important intellectual content. J.K.C., B.M.M., and G.A. assisted with the data acquisition and analysis. L.M.L. and A.L.C. reviewed the important intellectual content presented in the manuscript. A.L.C., J.K.C., and M.W.K. performed treatment procedures and critically revised the important intellectual content. All authors read and approved the final manuscript.

All individual identifying information, including age and sex, have been meticulously anonymized to achieve appropriate anonymity in the manuscript. The patient provided her informed consent to participate in this study and for the publication of his case report.

Received: 14 September 2023

Accepted: 02 December 2023

Article published online:
12 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany