• Keon-Yeup Kim and Sang-Hun Lee.
• Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
• Medicine (Baltimore). 2021 May 28; 100 (21): e25696e25696.

RationaleFree-floating thrombi in the intracranial artery are rare. We report a case of a free-floating and spinning thrombus caused by turbulent flow distal to the basilar artery stenosis. We compare thrombus changes in a series of images according to time and describe the approach to treatment and thrombosis resolution..Patient ConcernsA 55-year-old man presented to the emergency department on March 21, 2020, with left-sided weakness, bilateral limb ataxia, and a one-day history of dysarthria. Brain magnetic resonance imaging showed multifocal infarctions in the pons and cerebellum with severe basilar stenosis.DiagnosesDigital subtraction angiography showed severe focal stenosis. A relatively large oval-shaped mobile thrombus was observed spinning due to turbulent flow at the distal portion of the stenosis.InterventionsWe administered a combination antithrombotic regimen of warfarin and clopidogrel for 50 days.OutcomesNo thrombus was observed on the third follow-up digital subtraction angiography.LessonsNo previous study has directly observed a mobile thrombus in the intracranial artery using digital subtraction angiography. We used a combination antithrombotic strategy, which was effective after long-term, rather than short-term, use.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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