An aortic arch floating thrombus is a rare cause of embolic ischaemic cerebral infarction. Previously, thrombolysis or mechanical thrombectomy has been used to treat acute cerebral infarction in this context; however, combination therapy using both modalities is yet to be published. The optimal management of aortic arch floating thrombi is debated. Endovascular removal, thrombolysis, vitamin K antagonists and recently, direct oral anticoagulants have been utilised to treat aortic arch floating thrombi. Herein, we highlight the case of a patient presenting with dense hemiparesis, dysphasia and chest pain. CT imaging revealed a left middle cerebral artery thrombus and concurrent aortic arch floating thrombus. He was successfully treated with acute thrombolysis and subsequent mechanical thrombectomy of the cerebral thrombus resulting in resolution of his neurological symptoms. Repeat imaging demonstrated persistence of the aortic arch floating thrombus despite thrombolysis. The aortic arch floating thrombus was managed successfully with direct oral anticoagulant therapy.
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Contributors YZU and KA were responsible for drafting the manuscript and subsequent revisions. GC and LS contributed to critical revision of the manuscript for important intellectual content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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