[Shrinkage of carotid plaque in a patient with transient ischemic attack]

Area of Science:

• Vascular Neurology
• Cardiology
• Radiology

Background:

• Transient ischemic attacks (TIAs) are critical warnings of potential stroke.
• Carotid artery stenosis is a major risk factor for TIAs and ischemic stroke.

Observation:

• A 65-year-old male presented with recurrent TIAs, including neck pain and transient left-hand weakness.
• Carotid ultrasonography revealed severe stenosis and ulceration of the right common carotid artery plaque, predominantly hypoechoic with a hyperechoic base.
• MR imaging showed superficial borderzone white matter hyperintensities on FLAIR, but no acute diffusion-weighted imaging abnormalities or intracranial stenosis.

Findings:

• The patient was diagnosed with TIAs secondary to right carotid artery stenosis.
• Following initiation of aspirin therapy, the patient remained clinically stable with no further TIAs.
• Follow-up carotid ultrasonography at three months demonstrated significant plaque regression, with near-complete resolution of the hypoechoic component.

Implications:

• This case suggests that TIAs from carotid stenosis may be reversible.
• The observed plaque regression could be attributed to the resolution of atheroma gruel or intraplaque hemorrhage.
• These findings highlight the potential for dynamic changes in carotid plaque morphology and the effectiveness of antiplatelet therapy in managing TIA symptoms.