Histological examination of carotid endarterectomy specimens from two patients with sudden occlusive thrombosis revealed that blood flow was maintained through neovascularization within an organized thrombus in moderately stenotic atherosclerotic plaques.
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Neovascularization may maintain patency in occlusive carotid thrombi; hypothesis-generating and should not yet change practice.
Two patients presented with sudden onset of occlusive thrombosis of the atherosclerotic carotid artery. The patients underwent carotid endarterectomy. Histological examination of the specimens clearly showed the presence of pre-existing atherosclerotic plaque with moderate stenosis and occlusive organized thrombus. Blood flow was maintained through a honeycomb pattern of multiple neovascularization within the organized thrombus. These cases suggest that both the degree of stenosis and the plaque characteristics should be considered when evaluating the risk of stroke in patients with carotid artery stenosis.
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Yoshida et al. (2008) studied this question.
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