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Introduction Free-floating thrombus (FFT) of the internal carotid artery is a rare vascular condition associated with high risk of cerebral ischemic events. Due to limited data and absence of standardized protocols, its management remains debated. Treatment options include medical therapy, surgical intervention, and endovascular techniques, selected based on individual patient profiles.Abstract C79 Figure 1Case Description We present three clinical cases of FFT managed with different approaches: medical, surgical, and neurointerventional. In each case, treatment decisions were made through a multidisciplinary evaluation, taking into account factors such as symptom severity, thrombus characteristics, and overall clinical context. Each strategy resulted in a favorable clinical outcome, emphasizing the importance of tailored management.Abstract C79 Figure 2Conclusions Management of FFT of the internal carotid artery remains controversial, with no clear consensus in the literature. Our case series illustrates the need for a tailored approach and supports the call for prospective studies and evidence-based guidelines to aid clinicians in choosing the most appropriate treatment strategy.Abstract C79 Figure 3Conflict of Interest No