Objective:

A non-aneurysmal, non-atherosclerotic descending aortic arch thrombus (NAADTA) is a rare condition that can cause a stroke. The primary objective of this study is to report our experience regarding the diagnosis and management of thrombus in the non-aneurysmal, non-atherosclerotic descending thoracic aorta (NAADTA).

Background:

A free-floating thrombus within the ascending aorta, displaying normal morphology, is uncommon. However, if such a thrombus does develop, it can precipitate systemic embolism or even a life-threatening stroke. The underlying pathophysiological processes governing the formation of aortic mural thrombi remain poorly understood, and there exists no consensus on the optimal therapeutic interventions.

Design/Methods:

This abstract presents the case of a 43-year-old gentleman who presented with sudden onset giddiness and left-sided limb incoordination. Upon examination, left-sided cerebellar signs and the absence of a left radial pulse were noted. Urgent MRI brain with MRA confirmed a left cerebellar infarct and occlusion of the left vertebral artery. Due to high clinical suspicion, a CT aortogram was conducted, revealing a substantial, unstable, pedunculated thrombus within the aorta with significant embolization potential.

Results:

Immediate CTVS surgical review was done and the option for TVAR + Aortic Graft Stenting was contemplated, however in view of good response to Intravenous Heparin therapy, the surgical intervention was deferred. Patient is currently doing better on oral anticoagulation therapy and is under a very close follow up.

Conclusions:

1) We recommend that imaging for acute stroke patients should include a comprehensive assessment of the aortic arch, especially in those with a suspected hypercoagulable condition.

2) A floating thrombus in the aortic arch, though less frequently recognized, is a dangerous source of emboli that can affect the brain, vital organs, and limbs, posing significant risks for both morbidity and mortality.

3) Managing mural thrombus in non-atherosclerotic aortic dissection with thrombus formation (NAADTA) can be particularly challenging, especially when an underlying malignant or hypercoagulable disorder is present. Treatment should be tailored to the individual patient.

4) While there is no clear consensus in the literature, therapeutic anticoagulation is often recommended as the first-line treatment. Surgical intervention may be necessary in cases of contraindication to anticoagulation, presence of a mobile thrombus, or recurrent embolism.

5) This case highlights the successful medical management of a potentially fatal NAADTA-induced stroke, without the need for surgical intervention.