Stroke from an External Carotid: Lesion Pattern and Mechanisms

Area of Science:

• Vascular Surgery
• Neurology
• Cardiology

Background:

• External carotid artery stenosis typically causes localized symptoms like jaw claudication or facial pain.
• Cerebrovascular events are rare presentations of external carotid artery disease, usually involving the internal carotid artery.

Observation:

• A patient presented with an ischemic stroke attributed to a paradoxical embolism originating from the external carotid artery.
• Imaging revealed plaque ulceration at the external carotid artery origin and a floating thrombus extending into the internal carotid artery.

Findings:

• Duplex ultrasound and CT scan confirmed a pathologic left external carotid artery with a floating thrombus.
• Surgical thromboendarterectomy of the external carotid artery was performed six days after symptom onset, revealing plaque rupture and extensive clot.

Implications:

• This case highlights a rare mechanism of stroke due to external carotid artery disease.
• Prompt diagnosis and surgical management are crucial for preventing recurrent embolic events in such cases.