In the present study, we discuss the accuracy of digital subtraction angiography (DSA) in diagnosis of thrombus in the common carotid artery and its role in the medical management of this disorder. Between 2006 and 2011, four patients (age group ranging from 26 to 48 years) presented to our institution with symptoms of stroke. DSA in all these patients showed cigar-shaped filling defect in the common carotid artery. All the patients were managed successfully with anticoagulation treatment. Follow-up Duplex scan was done in all the patients. DSA is the gold standard to diagnose free floating thrombus in the common carotid artery. Medical management can be effective in these patients but a multidisciplinary team approach is needed for appropriate management.