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Carotid free-floating thrombus in patients with acute ischaemic stroke and active cancer
  1. Rita Monteiro Ventura1,
  2. Inês Freire2,
  3. João Pedro Marto1,3
  1. 1Department of Neurology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
  2. 2Department of Neuroradiology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
  3. 3Centro Clínico Académico de Lisboa (CCAL), NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
  1. Correspondence to Dr João Pedro Marto, Department of Neurology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; joao.pedro.seabra.marto{at}gmail.com

Abstract

In patients with ischaemic stroke, a carotid free-floating thrombus (CFFT) raises diagnostic and therapeutic challenges. We describe two women, each taking tamoxifen for invasive non-metastatic breast cancer, who developed large-vessel occlusion ischaemic strokes. The first had a CFFT 24 hours after receiving intravenous thrombolysis and mechanical thrombectomy; the thrombus completely resolved after 1 week of therapeutic anticoagulation. The second had a tandem occlusion with a CFFT at admission; her neurological deficits rapidly improved after intravenous thrombolysis without needing a mechanical thrombectomy. However, subsequently, under therapeutic anticoagulation, distal migration of the CFFT caused a recurrent large vessel occlusion ischaemic stroke, requiring mechanical thrombectomy. The CTFF in both cases appeared to relate to a cancer-related prothrombotic state. Both received long-term oral anticoagulation and their tamoxifen was switched to anastrozole. At 3 months, both were functionally independent without recurrent vascular events.

  • STROKE
  • CEREBROVASCULAR DISEASE

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Footnotes

  • Contributors RMV: original draft and writing–review and editing. IF: writing–review and editing. JPM: writing–review and editing.

  • 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 reviewed by David Werring, London, UK.

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