{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T01:46:35Z","timestamp":1789263995082,"version":"build-2803163510"},"reference-count":18,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background and Aim: Floating aortic thrombi are rare but potentially life-threatening entities, associated with a high risk of systemic embolization and subsequent complications such as ischemic stroke or mesenteric infarction. Therapeutic strategies range from urgent surgical intervention to conservative medical management with anticoagulation, depending on the patient\u2019s clinical status and thrombus morphology. This report presents two cases of floating aortic thrombi managed with distinct approaches, surgical and medical, underscoring the importance of individualized treatment guided by embolic risk and comorbidities. Patients and Methods: The first case involves a 59-year-old male presenting with abdominal pain and emesis. Imaging confirmed mesenteric ischemia, necessitating emergent laparotomy and extensive jejunal resection. Postoperative imaging identified a mobile thrombus at the ascending aorta\u2013aortic arch junction, with evidence of cerebral embolism. The patient underwent urgent surgical thrombectomy, ascending aortic resection, and hemiarch replacement. The second case describes an 88-year-old male who presented with bilateral upper limb paresthesia. Neuroimaging revealed acute supra- and infratentorial ischemic lesions suggestive of embolic stroke. A floating thrombus was identified in the ascending aorta, with an additional thrombus in the descending thoracic aorta. Given the patient\u2019s advanced age, comorbid conditions, and thrombus stability, a conservative approach with systemic anticoagulation and close radiologic surveillance was chosen. Conclusions: These cases illustrate the need for tailored management of floating aortic thrombi. While surgical resection remains indicated in unstable or high-risk embolic cases, anticoagulation may suffice for stable lesions in patients with elevated surgical risk. Further studies are needed to establish standardized therapeutic guidelines.<\/jats:p>","DOI":"10.3390\/jcdd12070248","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T03:33:25Z","timestamp":1750995205000},"page":"248","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Floating Thrombus on the Ascending Aorta and\/or Aortic Arch, to Operate or Not to Operate: Two Case Reports and a Literature Review"],"prefix":"10.3390","volume":"12","author":[{"given":"Estelle","family":"Demoulin","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Surgery, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205 Gen\u00e8ve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5325-677X","authenticated-orcid":false,"given":"Jalal","family":"Jolou","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Surgery, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205 Gen\u00e8ve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raoul","family":"Schorer","sequence":"additional","affiliation":[{"name":"Division of Peri-Interventional Care, Department of Anaesthesiology-Intensive Care and Pharmacology, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205 Gen\u00e8ve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Walder","sequence":"additional","affiliation":[{"name":"Division of Peri-Interventional Care, Department of Anaesthesiology-Intensive Care and Pharmacology, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205 Gen\u00e8ve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9836-7139","authenticated-orcid":false,"given":"Carl","family":"Glessgen","sequence":"additional","affiliation":[{"name":"Division of Radiology, Department of Diagnostic, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205 Gen\u00e8ve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Huber","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Surgery, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205 Gen\u00e8ve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Cikirikcioglu","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Department of Surgery, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205 Gen\u00e8ve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"ref_1","first-page":"e32212","article-title":"A Ticking Time Bomb: A Case of Floating Distal Aortic Arch Intraluminal Thrombus","volume":"14","author":"Ghoweba","year":"2022","journal-title":"Cureus"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1161\/01.CIR.96.1.321","article-title":"Comparison of human tissues and mechanical prostheses for aortic valve replacement in children","volume":"96","author":"Lupinetti","year":"1997","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1016\/j.amjmed.2015.07.027","article-title":"Mobile Menace: Floating Aortic Arch Thrombus","volume":"129","author":"Schattner","year":"2015","journal-title":"Am. 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