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NEUROIMAGE
Year : 2013  |  Volume : 61  |  Issue : 6  |  Page : 700-701

Mobile floating carotid plaque in a young woman


Department of Emergency Neurology, Emergency Centre, Clinical Centre of Vojvodina, Novi Sad, Serbia

Date of Web Publication20-Jan-2014

Correspondence Address:
Sonja Lukic
Department of Emergency Neurology, Emergency Centre, Clinical Centre of Vojvodina, Hajduk Veljkova 1, Novi Sad
Serbia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.125409

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How to cite this article:
Lukic S, Prokin AL, Zivanovic Z, Zekic TK, Sekaric J, Gvozdenovic S. Mobile floating carotid plaque in a young woman. Neurol India 2013;61:700-1

How to cite this URL:
Lukic S, Prokin AL, Zivanovic Z, Zekic TK, Sekaric J, Gvozdenovic S. Mobile floating carotid plaque in a young woman. Neurol India [serial online] 2013 [cited 2019 Jun 27];61:700-1. Available from: http://www.neurologyindia.com/text.asp?2013/61/6/700/125409


A 32-year-old white woman presented with acute onset of right limb weakness, 3 days before hospitalization. She had non-regulated hyperthyreoidism and a history of smoking. Brain computed tomography (CT) showed a several occipital and high parietal ischemic lesions of the left hemisphere [Figure 1]a and b. Duplex ultrasonography scan (DUS) showed the existence of fibrolipid plaque located on the back wall of the common carotid artery, that extended to the external as well as internal carotid artery making an uneven plaque, a part of which moved up and down with the heart beat, creating stenosis of 80-90% [Figure 1]c and d. CT angiography revealed unstable plaque in left internal carotid artery that protrudes into the lumen as well as moderate stenosis in the proximal segment of the external carotid artery [Figure 2]. She underwent total carotid endarterecotomy of symptomatic left internal carotid artery, 25 days after being admitted. Histopathological finding indicated that the plaque was atherosclerotic. In the prevention of stroke recurrence, the patient was given 75 mg of clopidogrel and 100 mg of aspirin daily. The patient did well, with residual discrete right-sided weakness and no recurrent strokes. Follow-up DUS was done and it showed no signs of plaque or restenosis.
Figure 1: Brain computed tomography showed several occipital and high parietal ischaemic leasions of the left hemisphere (a, b). Duplex ultrasonography scan revealed fibrolipid plaque located on the back wall of the common carotid artery, that extended to the external as well as internal carotid artery making an uneven plaque (c, d)

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Figure 2: Computed tomographic angiography of the neck showed unstable plaque in left internal carotid artery that protrudes into the lumen as well as moderate stenosis in the proximal segment of external carotid artery. Axial source imaging (a, b) and 3D reconstruction imaging (c, d)

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Mobile carotid plaques are unstable and associated with recurrent stroke, [1] with the estimated prevalence of 1 in 2000. [2] They bear high risk of embolic cerebrovascular incidents, as was the case in our patient. This type of plaque usually represents degenerated atherosclerotic flap, ruptured plaque with mobile thrombus or intimal dissection plaque. The only method that can show the mobility of the plaque is ultrasonography. [1] Mobile floating carotid plaques can be treated with urgent carotid endarterectomy, delayed carotid endarterectomy and carotid angioplasty and stenting. [2],[3] Beside surgery, patients are treated with antiplatelet therapy. [2]

 
  References Top

1.Ogata T, Yasaka M, Wakugawa Y, Kitazono T, Okada Y. Morphological classification of mobile plaques and their association with early recurrence of stroke. Cerebrovasc Dis 2010;30:606-11.  Back to cited text no. 1
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2.Chakhtoura EY, GoldsteinS JE, Hobson RW. Management of mobile floating carotid plaque using carotid artery stenting. J Endovasc Ther 2003;10:653-6.  Back to cited text no. 2
    
3.Ferrero E, Ferri M, Viazzo A, Labate C, Pecchio A, Berardi G, et al. Free-floating thrombus in the internal carotid artery: Diagnosis and treatment of 16 cases in a single center. Ann Vasc Surg 2011;25:805-12.  Back to cited text no. 3
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