This systematic review and meta-analysis seeks to assess and update the existing literature on FFT management strategies and their corresponding outcomes. It also provides an insight into the sociodemographic distribution and morbidity associated with FFT.

Free floating thrombus (FFT) is a rare clinical condition with the potential risk of embolization, leading to acute ischemic stroke or transient ischemic attack. The optimal management for FFT remains uncertain.

We searched PubMed and EMBASE databases for references reporting FFT in the anterior or posterior circulation. We estimated the frequency of stroke/TIA recurrence and mortality for each treatment group. A proportion meta-analysis was performed on complete revascularization data for both groups. Complication rates were also evaluated for each group.

In managing FFT patients, procedural intervention offers higher revascularization rates potentially reducing stroke recurrence but carries greater mortality and complication risks compared to medical treatment. Robust, extended-duration research, particularly randomized controlled trials (RCTs), are essential for generating more reliable outcomes.