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Background: Ascending aortic thrombus has been reported in several case reports, often revealed by peripheral embolization, but very few revealed by cardiocerebral infarction. Moreover, there is no defined treatment strategy., Case Summary: An 83-year-old woman was admitted to our intensive care unit for concurrent acute myocardial infarction (AMI) and acute stroke, both with the presence of an embolism. Imaging revealed a floating thrombus in the ascending aorta. The thrombus resolved after anticoagulant therapy was administered, and there was no subsequent embolism recurrence., Discussion: Floating thrombus in the ascending aorta is an unusual cause of AMI. The main mechanisms of thrombus formation include erosion of an atherosclerotic plaque, but it can also form without tissue abnormality with the probable implication of Virchow's triad. However, the precise mechanism for thrombogenesis remains unknown. In patients with a low surgical risk, we should consider surgical treatment, especially as anticoagulant therapy does not appear to reduce the risk of arterial embolization. Thrombolysis and endovascular interventions have also proven effective in certain cases. Overall, in patients with high surgical risk, decision will have to be made on a case-by-case basis., Keywords: Acute myocardial infarction • Embolic stroke • Coronary embolism • Ascending aorta thrombus • Floating thrombus • Case report., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)