Key result
Floating vulnerable carotid plaque linked to acute ischemic stroke without significant stenosis.
Why the study?
Mobile atheromatous plaques in large arteries are a major risk factor for embolic strokes, and the etiopathogenesis of inflammation within unstable vulnerable plaques remains unclear.
Case Report (n=1)
No
This case highlights that unstable vulnerable carotid plaques can cause extensive embolic strokes, emphasizing the importance of early identification of plaque vulnerability using imaging modalities.
May prompt evaluation of plaque vulnerability beyond stenosis in stroke; leaves open whether advanced imaging changes management.
Mobile atheromatous plaques affecting large arteries are a major risk factor for embolic strokes. We report a case of extensive embolic cerebral infarction secondary to a vulnerable internal carotid artery plaque. A 67-year-old female was admitted with sudden left-sided weakness. A computed tomography brain scan revealed early ischemic changes in the right middle cerebral territory. The ultrasound Doppler showed soft mobile plaque with thrombus in the right internal carotid artery causing 90% stenosis. Magnetic resonance imaging brain scan performed later showed extensive right cerebral infarction. A computed tomography angiogram revealed ulcerated non-occlusive soft tissue plaque in the right internal carotid artery. She was also diagnosed with bladder cancer during this admission and was managed medically due to her performance status. Unstable vulnerable plaques can be symptomatic even in the absence of significant carotid stenosis. Hence, early identification of the plaque vulnerability, using new imaging modalities, and its medical stabilization can help to reduce the risk of cerebrovascular insults. The etiopathogenesis of inflammation within unstable vulnerable plaques and its concordance with inflammatory markers is still unclear. It is feasible in our case the malignantprocess could also be contributing to the inflammation within the blood vessels promoting vulnerability of the plaques.
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Eltemamy et al. (2023) conducted a case report in Acute ischemic stroke (n=1). Medical management (aspirin and statin) was evaluated. A 67-year-old female with acute ischemic stroke was found to have a floating vulnerable plaque in the right internal carotid artery, demonstrating that unstable plaques can be symptomatic without significant stenosis.
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