Caso Clinico S3

Instrucciones: 

Specifics:

 Must follow the presentation rules by the med school

 The review must be from the case report document “Free floating and spinning
thrombus of the basilar artery”.
 The document must be written on English language by handwriting
 Take a picture or scan the document, and upload it to med school web
 The student must realize a summary document about the case report “Free
floating and spinning thrombus of the basilar artery”, the student can access the
document on the med school web site.
 Free-floating and spinning thrombus of the basilar artery
A free floating thrombus is an elongated thrombus attached to the arterial wall with circumferential
blood flow at the distal aspect. Atherosclerosis is reported to be the most common etiology, however
the natural history and etiology of free-floating thrombi in the cerebral circulation are unknown. The
most likely pathogenesis of a free floating thrombus is ruptured atherosclerotic plaque that increases
the risk for thrombus formation at the site. Free floating thrombus is an uncommon entity with variable
reported incidence depending on method of imaging used. Incidence has been reported to be as low as
0.05% in a retrospective study with ultrasonography used for carotid artery imaging.

There are multiple and diverse causes of carotid FFT formation. Atherosclerosis has been reported to be
the most common etiology. Carotid stenosis in itself with altered blood flow around the area of stenosis
would cause increased risk of FFT. FFT usually presents with acute neurological deficit, 92% of cases
have neurological symptoms and 4% are usually asymptomatic.

The presence of an intraluminal or free-floating thrombus is a therapeutic challenge because of the

associated risk of stroke. Also, empirical evidence to guide appropriate treatment strategies is lacking.
The most popular medical care plan initial treatment is initiate with heparin, however we can use
warfarin anticoagulant; some authors added antiplatelet drugs (aspirin or clopidogrel) to this regimen,
while others only administered antiplatelet drugs. Although there are no randomized drug treatment
trials, initial medical management with antithrombotic drugs (anticoagulants and antiplatelet drugs) is
safe for most patients.

In this patient the used a combination of antithrombotic regimens (warfarin and clopidogrel). A minimal
change in the DSA shape was observed after 7weeks, but it completely disappeared after 50 days. There
were no additional neurological changes or deterioration between the treatments, and no additional
ischemic changes were observed on follow-up MRI; therefore, the patient’s thrombus resolved due to
medical treatment, rather than distal migration.