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Circulation. 2003;107:e19-e20
doi: 10.1161/01.CIR.0000046345.41702.33
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(Circulation. 2003;107:e19.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Thrombus in the Internal Carotid Artery Complicating an "Unstable" Atheromatous Plaque

Luis A. Urbano, MD; Fabienne Perren, MD; Andrea O. Rossetti, MD; Ludwig Von Segesser, MD; Julien Bogousslavsky, MD; Gérald Devuyst, MD

From the Departments of Neurology (L.A.U., F.B., A.O.R., J.B., G.D.) and Cardiovascular Surgery (L.V.S.), CHUV, Lausanne, Switzerland.

Correspondence to Gérald Devuyst, MD, Service de Neurologie, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland. E-mail Gerald.Devuyst{at}chuv.hospvd.ch

A64-year-old man was admitted to the stroke unit after brief episodes of clumsiness and numbness of the left hand. Neurological examination disclosed a left hemisensory syndrome. Brain MRI revealed a subacute ischemic infarction in the right frontoparietal region. Extracranial ultrasound showed a nonstenotic, heterogeneous atheromatous plaque with interrupted fibrous cap (hyperdense cover) at the origin of the right internal carotid artery (ICA; Figure 1 and Movie I). The patient was discharged on anticoagulant treatment, but he was readmit- ted 20 days later for recurrence of brief, transitory left sensory symptoms. Extracranial ultrasound revealed an isoechoic pulsating mass attached to the known plaque in the right ICA (Figures 2 and 3 and Movies II and III), suggesting a floating thrombus. This was confirmed by magnetic resonance angiography. The patient underwent emergency thrombendarterectomy; a fresh thrombus complicating the above-mentioned plaque and suboccluding the right ICA was removed. Clinical evolution was favorable.



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  		Figure 1. Ultrasound B-mode of right ICA (longitudinal section). Atheromatous plaque with interrupted fibrous cap (arrows).



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  		Figure 2. Color duplex flow imaging of right ICA (longitudinal section). Isoechoic filling defect corresponding to a mobile thrombus.



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  		Figure 3. Color duplex flow imaging of right external carotid artery (arrow) and ICA (arrowhead) (transversal section). Image plane is within free-floating portion of thrombus in the ICA.

Footnotes

Movies I, II, and III are available in the online-only Data Supplement available at http://www.circulationaha.org.

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.





This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow Data Supplement
Right arrow Alert me when this article is cited
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Citing Articles
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Google Scholar
Right arrow Articles by Urbano, L. A.
Right arrow Articles by Devuyst, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Urbano, L. A.
Right arrow Articles by Devuyst, G.
Related Collections
Right arrow Arterial thrombosis
Right arrow Acute Cerebral Infarction
Right arrow Embolic stroke
Right arrow Doppler ultrasound, Transcranial Doppler etc.
Right arrow Transient Ischemic Attacks

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