颈动脉漂浮血栓（CFFT）是一种罕见但具有高栓塞风险的病变，常导致急性缺血性脑卒中或短暂性脑缺血发作。CFFT的发病机制尚未完全明确，主要与动脉粥样硬化斑块破裂有关。影像学检查在CFFT的诊断中发挥着核心作用。近年来，非侵入性影像技术逐渐成为主要诊断手段。尽管对CFFT的认识在不断加深，但由于病例相对罕见，缺乏大样本研究，目前CFFT的治疗尚无统一规范。现有治疗策略主要包括抗凝治疗、抗血小板治疗及外科或血管内干预治疗，近年来对CFFT的小样本观察性研究逐渐增多，但具体治疗方案仍存在争议。本研究综述了CFFT的流行病学、发病机制、影像学诊断及当前治疗策略，旨在总结最新研究证据，促进临床对该病的早期识别与规范化管理，并为未来开展高质量前瞻性研究提供参考。

Carotid free-floating thrombus (CFFT) is a rare but high-risk condition for embolic events, often leading to acute ischemic stroke or transient ischemic attack. The pathogenesis of CFFT remains incompletely understood, with most cases related to rupture of atherosclerotic plaques. Imaging plays a central role in the diagnosis of CFFT, and noninvasive imaging techniques have become the main diagnostic tools in recent years. Although understanding of CFFT has deepened, the rarity of cases and lack of large-scale studies mean that standardized treatment guidelines are still unavailable. Current treatment strategies mainly include anticoagulation, antiplatelet therapy, and surgical or endovascular intervention. Despite the increasing number of recent small-scale observational studies on CFFT, the optimal management strategy remains controversial. This review summarizes recent evidence on the epidemiology, pathogenesis, imaging diagnosis, and current treatment strategies of CFFT, aiming to enhance early recognition and standardized management in clinical practice and to provide insights for future high-quality prospective studies.