Abstract Details

Title Efficacy and Safety of Anticoagulant and Antiplatelet Therapies in the Medical Management of Carotid Free-Floating Thrombus: a Systematic Review

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S30 - Stroke Risk Factors, Outcomes, and Prevention (5:06 PM-5:18 PM)

Poster/Presentation
Number 009

Background The optimal treatment for CFFT remains uncertain due to limited evidence, with no randomized clinical trials (RCTs) and scarce guidelines, such as ESVS 2023, favoring conservative management. ACT and antiplatelet APT therapies are emerging as promising alternatives to high-risk surgical interventions.

Objective To evaluate the safety and efficacy of anticoagulation (ACT) and antiplatelet (ATP) therapies for carotid free-floating thrombus (CFFT).

Design/Methods A systematic search following PRISMA guidelines was performed across PubMed, Embase, Web of Science, and Cochrane databases. Safety and efficacy endpoints were assessed. A two-sample t-test compared baseline characteristics, and a Chi-square test evaluated differences in categorical variables between groups. Statistical significance was set at p < 0.05. Data were analyzed using R 4.3.0 with the meta package v.7.0-0.

Results Four studies met the inclusion criteria, involving 170 patients diagnosed with CFFT. The APT group included 96 patients (mean age 55.35 ± 13.52 years; 56.25% male), and the ACT group included 74 patients (mean age 58.57 ± 14.28 years; 51.35% male). Median NIHSS ranged from 8-10 in the APT group versus 2-7 in the ACT group. The chi-square test of independence found no significant statistical difference between variables of sex, age, or ethnicity between the two groups. On the other hand, medical comorbidities differed among the ACT and APT groups (p<0.001). Thrombus regression was slightly lower in APT (42%) compared to ACT (48%). Both groups showed similar rates of residual stenosis. APT had fewer ischemic events within 30 days (none vs. 4% in ACT) and lower intracranial hemorrhage rates (3.3% vs. 5.4% in ACT) but higher mortality (6.3% vs. none in ACT).

Conclusions

Both ACT and APT effectively manage CFFT with distinct efficacy and safety entities. However, RCTs are necessary to avoid selection bias, such as the lower NIHSS range in the ACT group, and to better assess these therapies in CFFT treatment.

Authors/Disclosures
Marina Vilardo PRESENTER	Miss Vilardo has nothing to disclose.
Raphael Camerotte	Raphael Camerotte has nothing to disclose.
Filipe V. Ribeiro, MD	Ms. Ribeiro has nothing to disclose.
Jhon E. Bocanegra-Becerra	Mr. Bocanegra-Becerra has nothing to disclose.
Ocilio R. Goncalves, MS	Mr. Goncalves has nothing to disclose.
Dominique H. Montecino, MD	Dr. Montecino has nothing to disclose.
Bruna Leles Vieira de Souza, MD	Miss Leles Vieira de Souza has nothing to disclose.
Luis Paleare, MS	Mr. Paleare has nothing to disclose.
Saul Dominici, Sr.	Dr. Dominici has nothing to disclose.
Arthur P. Corvelo, Sr., Estudante de medicina	Mr. Corvelo has nothing to disclose.
Christian K. Fukunaga, MS (Medical Student)	Mr. Fukunaga has nothing to disclose.
Lucas P. Mitre	Dr. Mitre has nothing to disclose.
Marcio Yuri Ferreira	No disclosure on file
Ana Santos, MD	Ms. Santos has nothing to disclose.
Anthony Hong, MD	Dr. Hong has nothing to disclose.
Christian Ferreira, MD	Dr. Ferreira has nothing to disclose.
David Gordon (Phelps Hospital)	No disclosure on file
David Langer, MD (Roosevelt Hospital)	No disclosure on file
Yafell Serulle, MD, PhD	Dr. Serulle has nothing to disclose.

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