Distal migration of a floating carotid thrombus in a patient using oral contraceptives: a case report

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Introduction: We report the case of a patient with distal migration of a floating carotid thrombus caused by oral contraceptives.

Case presentation:
A 48-year-old woman using oral contraceptives suffered from dysarthria and gait disturbance. Examinations, including ultrasound and cerebral arteriogram, revealed a floating thrombus at the left carotid bifurcation with no stenosis. Despite antithrombotic therapy, the floating carotid thrombus migrated to the ipsilateral middle cerebral artery, resulting in a severe stroke.

Some floating thrombi are resistant to conservative therapy and have a risk of distal migration, which may cause a major stroke in the acute stage.


Carotid endarterectomy (CEA) is the standard treatment for extracranial carotid occlusive diseases. However, determining a more appropriate therapy, surgery or medicalmanagement, for treating a floating thrombus in the carotid artery is controversial. Some reports have recommended conservative therapy such as antithrombotic drugs [1,2],while others have diagnosed the floating thrombus as a critical lesion and recommended aggressive therapy, including emergent CEA [3]. In this report, we describe the distal migration of a floating carotid thrombus to the ipsilateral middle cerebral artery despite intensive antithrombotic therapy.


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