Acute Symptomatic Free-Floating Thrombus in the Innominate Artery, a Case Series.

Background: Innominate artery embolism may result in upper extremity ischemia or stroke. A free-floating thrombus originating from the IA is an unusual and dangerous disorder with embolic potential. Only isolated cases have been described showing different treatment modalities.

Purpose: To present 3 cases of free-floating thrombus in the IA treated at our institution with 3 different approaches.

Cases: The first case is a patient with a free-floating thrombus in the IA treated with cervical debranching and ligation of the proximal right carotid artery; another case of a patient treated with a hybrid approach with deployment of an iliac limb in the IA plus right carotid to subclavian bypass; and a third case of a patient operated by open arch thrombectomy.

Conclusions: Free-floating thrombus in the IA is a threatening condition feasible to be managed through different customized surgical approaches in specialized centers.