Pearls & Oy-sters: Recurrent Stroke From a Nonstenotic Carotid Plaque
Jie Wang1, Bin Yang1, Wei Gao2
1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Insights
Vulnerable plaques in carotid arteries can cause recurrent strokes even without significant narrowing. High-resolution imaging is crucial for detecting these high-risk, non-stenotic plaques and improving stroke risk assessment.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Radiology
Background:
- Conventional imaging may miss the stroke risk posed by non-stenotic plaques.
- Identifying high-risk plaque features is critical for accurate ischemic stroke etiology.
Purpose of the Study:
- To highlight the role of vulnerable, non-stenotic plaques in recurrent ischemic strokes.
- To emphasize the importance of advanced imaging in characterizing carotid plaques.
Main Methods:
- Case report of a 66-year-old male with recurrent strokes.
- Utilized carotid ultrasound, digital subtraction angiography, high-resolution MRI, and postoperative pathology.
- Focused on plaque morphology and composition.
Main Results:
- Despite no significant carotid stenosis on conventional imaging, the patient had recurrent strokes.
- High-resolution MRI and pathology revealed a vulnerable plaque with positive remodeling, fibrous cap rupture, and intraplaque hemorrhage.
- Confirmed non-stenotic plaques can be a source of embolism.
Conclusions:
- Vulnerable carotid plaques, even without significant stenosis, are a critical cause of ischemic stroke.
- High-resolution imaging techniques are essential for identifying high-risk plaque features.
- Improved plaque characterization can refine stroke etiology assessment and risk stratification.
Abstract:
In the etiologic assessment of ischemic stroke, conventional imaging techniques may underestimate the clinical significance of high-risk plaques that do not exhibit significant luminal stenosis. Here, we report the case of a 66-year-old male patient who experienced 3 recurrent strokes. Carotid ultrasound and digital subtraction angiography showed no apparent carotid stenosis. However, high-resolution MRI and postoperative pathology revealed a plaque in the common carotid artery with vulnerable features including positive remodeling, fibrous cap rupture, and intraplaque hemorrhage. This case highlights that vulnerable plaques can pose a risk of stroke even when stenosis is only mild and underscores the pivotal role of high-resolution imaging techniques in identifying plaque characteristics to refine stroke etiology assessment. This case provides valuable insight into the high-risk nature of nonstenotic plaques and supports the optimization of stroke risk stratification strategies.
More Related Videos
09:11Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability
Published on: February 23, 2016
06:59Middle Cerebral Artery Occlusion Allowing Reperfusion via Common Carotid Artery Repair in Mice
Published on: January 23, 2019
Related Concept Videos
01:26Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
01:30Peripheral Artery Disease I: Introduction
01:30Atherosclerosis I: Introduction