Carotid Artery Angioplasty and Stenting for Atherosclerotic Plaque with Mobile Intimal Flap

Atherosclerotic carotid stenosis associated with a mobile carotid plaque (MCP) is a relatively rare entity, observed in less than 1 in 2,000 carotid ultrasound examinations. As such, the natural history of this lesion and risk for neurological thromboembolic complications are not well defined. Small case reports have described treatment varying from medical management with anticoagulation, to carotid endarterectomy, and more recently, carotid stenting. We present two patients with carotid stenosis associated with a MCP. A distinct MCP component that varied with the cardiac cycle was clearly delineated on ultrasound in both patients. Intravascular ultrasound (IVUS) at the time of carotid stenting confirmed the MCP. Successful carotid angioplasty and stenting was performed in both patients with resolution of the MCP documented on IVUS and follow-up duplex ultrasound. Although the definitive treatment method remains uncertain, carotid stenting is a viable option for treatment in patients with MCPs.