Thrombus in the Internal Carotid Artery Complicating an “Unstable” Atheromatous Plaque
A 64-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.
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.
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