Background: Carotid free-floating thrombus (CFFT) is an uncommon disorder. The aim of this study was to describe a French cohort of CFFT patients. Methods: We conducted a retrospective monocentric study from a Stroke Center among patients admitted for stroke with CFFT. Results: Between January 2017 to December 2019, 2038 ischemic strokes were recorded. A total of 50 patients with CFFT were consecutively included (32 men/18 women). The mean age was 58.2 years (±11.7). Their etiologies were atheroma (46%), carotid dissection and web (20%), hypercoagulability disorders (16%) and arrhythmia (10%). Exclusive medical management was performed in 38 patients (76%): 29 (59.2%) were anticoagulated and 9 (18.4%) received antiplatelets alone in the first week. Surgical intervention was performed in the first 30 days for 11 patients (22%). The main surgical indication was a residual carotid stenosis over 70%. Only three patients had a recurrent stroke in the medical group with anticoagulants. No patients in the antiplatelet group or the surgical group had a recurrent stroke. Conclusions: Our study summarized a large cohort of 50 patients with CFFT. This diagnosis implies the need to search for a local arterial disease and to screen for hypercoagulability states. An initial medical strategy followed by a delayed carotid surgery if the follow-up imaging shows a residual stenosis appears to be safe.

Carotid atherosclerotic stenosis (CAS) is a leading cause of ischemic stroke. Current understanding of plaque vulnerability remains largely confined to histopathological characterization. Consequently, identifying molecular determinants of plaque stability represents a major challenge to advance prevention strategies. Untargeted metabolomic analysis was performed using mass spectrometry coupled to liquid chromatography on carotid plaques removed from patients with CAS undergoing endarterectomy. To identify factors influencing plaque stability, we compared 42 asymptomatic with 30 symptomatic CAS patients. Associations between each annotated metabolite in plaques and asymptomatic CAS status were assessed using logistic regression models. Asymptomatic patients exhibited lower plasmatic levels of C-reactive protein (CRP) and higher HDL-cholesterol. Within the plaques, caffeine and its catabolites, paraxanthine and methylxanthine, were associated with plaque stability and were correlated with HDL-cholesterol. Additional plant-based diet biomarkers including N5-acetylornithine, gentisic acid, proline betaine, and homostachydrine were also associated with plaque stability. In contrast, N-methylpyridone carboxamides, reflecting niacin excess, involved in vascular inflammatory processes, were both associated with plaque vulnerability and also correlated with higher CRP. Our findings provide molecular evidence that plant-based diets, including coffee, promote carotid plaque stability, while excessive niacin intake, linked to processed foods, may be detrimental. Metabolomics offers new insights into food exposome-related vascular risk.

Late ischaemic consequences of type A aortic dissection are rare. We present a 6-year late complication of type A aortic dissection treated by Bentall surgery in a 41-year-old patient. The patient presented with several episodes of lipothymia associated with hypertensive attacks with anisotension, cervicalgia, hemicranial headache, abdominal pain and lower limb slipping initially on exertion and later at rest. On dynamic examination, we diagnosed an intermittent dynamic occlusion of the aortic arch and rare LOX gene variation, which is considered to be associated with aneurysm or dissection of the ascending aorta in young patients. Surgical treatment by replacement of the ascending aorta and the aortic arch with reimplantation of the brachiocephalic trunk (BcTr) allowed the symptoms to resolve.