Challenges in Managing Carotid Free-floating Thrombus in Marfan Syndrome: A Case Report and Therapeutic Considerations.

Carotid free-floating thrombus (CFFT) is an uncommon vascular condition involving an elongated thrombus that extends in the direction of distal blood flow, remaining only partially attached to the artery wall. Risk factors include atherosclerosis, hypercoagulable states, and vascular trauma. Symptoms of CFFT can include sudden unilateral weakness or numbness, slurred speech, visual disturbances, dizziness, and headaches, which may indicate a transient ischemic attack or stroke. However, due to its rarity, the optimal treatment strategies remain under investigation. Here, we present a unique case of a patient with Marfan syndrome who developed CFFT while on long-term warfarin therapy, effectively managed with enoxaparin. This case illustrates the role of arterial tortuosity and aneurysmal dilatation in thrombus formation as a manifestation of Marfan syndrome. It also emphasizes the complexities of managing CFFT, presenting a therapeutic dilemma due to the uncertainty surrounding optimal treatment strategies and shedding light on the need for further research to inform clinical decision-making.