{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T18:31:40Z","timestamp":1767205900073,"version":"build-2238731810"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tandem lesions (TLs), defined as simultaneous occlusions of both extracranial and intracranial arteries, represent a particularly challenging subset of large vessel occlusion (LVO) strokes. While most TLs are attributed to atherosclerotic changes or arterial dissection, a smaller subset originates from cardioembolic emboli arising from the heart or aortic arch, commonly referred to as embolic tandem lesions. In rare instances, these emboli form a free-floating thrombus (FFT) in the carotid artery, characterized by mobile intraluminal thrombotic material with high embolic potential. Optimal treatment strategies for these rare and complex cases remain undefined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>We present a rare case involving an embolic tandem lesion in a 73-year-old male with known atrial fibrillation who presented with acute ischemic stroke upon awakening. Imaging and angiography demonstrated a free-floating thrombus (FFT) at the brachiocephalic bifurcation extending into the origins of the right common carotid and right subclavian arteries, a free-floating thrombus at the carotid bifurcation, and an additional thrombus occluding the right ICA terminus and the origin of the M1 segment. A staged endovascular approach was employed: intracranial recanalization was first achieved via mechanical thrombectomy, followed by stent-assisted stabilization of the residual free-floating thrombus within the common carotid artery. The patient experienced significant neurological improvement and attained functional independence at 3-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case underscores the diagnostic and therapeutic complexity associated with embolic tandem lesions and carotid FFT involvement. Comprehensive preprocedural imaging, including assessment of the aortic arch and cervical vessels, is critical. A personalized, multi-modality endovascular approach combining thrombectomy and stenting can enable successful revascularization and favorable clinical outcomes, particularly when FFT complicates tandem occlusions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnins.2025.1654601","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T05:42:35Z","timestamp":1760506955000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Endovascular management of tandem embolic stroke due to cardioembolic free-floating thrombus: a case report"],"prefix":"10.3389","volume":"19","author":[{"given":"Bin","family":"Hu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"105626","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105626","article-title":"Acute endovascular revascularization for patients with common carotid artery occlusion apparent on cervical magnetic resonance angiography","volume":"30","author":"Asano","year":"2021","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1136\/neurintsurg-2017-013316","article-title":"Acute ischemic stroke with tandem lesions: technical endovascular management and clinical outcomes from the ESCAPE trial","volume":"10","author":"Assis","year":"2018","journal-title":"J. Neurointerv. Surg."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.jvs.2006.09.057","article-title":"Free-floating thrombus of the carotid artery: literature review and case reports","volume":"45","author":"Bhatti","year":"2007","journal-title":"J. Vasc. Surg."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1007\/s00062-020-00898-y","article-title":"Carotid stenting as definitive treatment for free floating thrombus-review of 7 cases","volume":"31","author":"Bhogal","year":"2021","journal-title":"Clin. Neuroradiol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1007\/s00234-018-2077-2","article-title":"Endovascular aspiration of a symptomatic free-floating common carotid artery thrombus","volume":"60","author":"Carr","year":"2018","journal-title":"Neuroradiology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1136\/svn-2022-001639","article-title":"Aetiology of extracranial carotid free-floating thrombus in a prospective multicentre cohort","volume":"8","author":"Dowlatshahi","year":"2023","journal-title":"Stroke Vasc. Neurol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1177\/1747493019828554","article-title":"Diagnosis and management of carotid free-floating thrombus: a systematic literature review","volume":"14","author":"Fridman","year":"2019","journal-title":"Int. J. Stroke"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e25","DOI":"10.1136\/neurintsurg-2016-012904.rep","article-title":"Stentriever thrombectomy with distal protection device for carotid free-floating thrombus: a technical case report","volume":"9","author":"Giragani","year":"2017","journal-title":"J. Neurointerv. Surg."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"801","DOI":"10.3390\/brainsci14080801","article-title":"The efficacy of medical interventions for free-floating thrombus in cerebrovascular events: a systematic review","volume":"14","author":"Jayyusi","year":"2024","journal-title":"Brain Sci."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"993559","DOI":"10.3389\/fneur.2022.993559","article-title":"Natural history of carotid artery free-floating thrombus-a single center, consecutive cohort analysis","volume":"13","author":"Muller","year":"2022","journal-title":"Front. Neurol."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1016\/j.jcin.2018.05.036","article-title":"Carotid stenting with antithrombotic agents and intracranial thrombectomy leads to the highest recanalization rate in patients with acute stroke with tandem lesions","volume":"11","author":"Papanagiotou","year":"2018","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"727","DOI":"10.3174\/ajnr.A7482","article-title":"Antithrombotic treatment after carotid stenting in patients with concomitant atrial fibrillation","volume":"43","author":"Pardo-Galiana","year":"2022","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e076161","DOI":"10.1136\/bmj-2023-076161","article-title":"Advances in treatments for acute ischemic stroke","volume":"389","author":"Sharma","year":"2025","journal-title":"BMJ"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"961760","DOI":"10.3389\/fcvm.2022.961760","article-title":"Case report: ultrasound-assisted endovascular therapy for carotid artery floating thrombus","volume":"9","author":"Wang","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"274","DOI":"10.25259\/SNI_513_2023","article-title":"Stent retrieval for free-floating thrombus attached to carotid artery stenosis: a report of two cases","volume":"14","author":"Yamamoto","year":"2023","journal-title":"Surg. Neurol. Int."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"293","DOI":"10.5797\/jnet.cr.2023-0050","article-title":"Mechanical thrombectomy using a large dual-layer stent retriever for near-occlusion of the common carotid bifurcation caused by a giant free-floating thrombus","volume":"17","author":"Yokoyama","year":"2023","journal-title":"J. Neuroendovasc. Ther."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e007971","DOI":"10.1161\/CIRCOUTCOMES.121.007971","article-title":"Off-label under- and overdosing of direct oral anticoagulants in patients with atrial fibrillation: a meta-analysis","volume":"14","author":"Zhang","year":"2021","journal-title":"Circ. Cardiovasc. Qual. 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