To describe clinical characteristics, vascular risk factors, treatment variability, and short-term outcomes in patients diagnosed with floating thrombus (FFT) of the cervical arteries.

FFT is an uncommon arterial pathology recognized as a high-risk embolic source capable of causing recurrent ischemic strokes or transient ischemic attacks. In the absence of standardized management, therapeutic choices vary widely among antiplatelet, anticoagulant, and thrombolytic strategies.
The European Society for Vascular Surgery (ESVS), in its 2023 guidelines, briefly addresses FFT, with treatment individualized according to thrombus morphology, embolic risk, and comorbidities.

This single-centre observational study included patients diagnosed with FFT on CT angiography at a tertiary hospital in India between January 2024 and September 2025. Clinical presentation, vascular territory, treatment modality, recurrence, and 90-day outcomes were analyzed. Management reflected physician discretion without a prespecified protocol.

Ten patients (mean age 39 years; 9 male) were identified. FFT involved the common carotid artery in 5 and internal carotid artery in 5. The median NIHSS at presentation was 3. Vascular risk factors included hypertension (30%), diabetes (20%), smoking (40%), and dyslipidemia (30%).
Therapies comprised dual antiplatelet therapy (4 patients), intravenous thrombolysis followed by antiplatelets (2), heparin with antiplatelet therapy (2), and thrombolysis with subsequent anticoagulation (2). Two patients underwent delayed stenting. Recurrent stroke occurred in one patient (10%), on dual antiplatelet therapy within 7 days. At 90 days, nine (90%) achieved functional independence (mRS 0–2), and one (10%) had moderate disability (mRS 3); no deaths or hemorrhagic complications were observed.

Despite generally favorable short-term outcomes, uncertainty persists regarding optimal antithrombotic intensity, duration, and timing of intervention. FFT remains a high-risk yet poorly defined cause of ischemic stroke. The creation of international registries, consensus definitions, and a pragmatic multicenter RCT comparing anticoagulation- and antiplatelet-based strategies is urgently needed to establish standardized guidelines and reduce unwarranted variation in care.