Calcified nodules in the cervical carotid artery

Calcified nodules (CNs) are a distinct morphological subtype of calcified plaques that cause acute coronary events. However, their clinical relevance in carotid artery disease remains poorly understood.

We report two cases of symptomatic carotid artery stenosis caused by CNs, both successfully treated with carotid endarterectomy (CEA). In both cases, computed tomography angiography (CTA) revealed severely stenotic lesions with bulky calcified plaques protruding into the vascular lumen. Plaque imaging with magnetic resonance imaging and carotid ultrasonography suggested the presence of calcified components. Surgical excision confirmed the diagnosis of CNs through pathological evaluation. Both patients had favorable outcomes with no neurological deficits on discharge. Notably, CNs are rarely reported in the context of carotid artery disease, and preoperative diagnosis remains challenging due to the lack of established imaging criteria. CTA may be a useful non-invasive tool for identifying CNs, as shown in coronary artery studies.

These cases demonstrate that CNs can cause severe carotid stenosis requiring CEA. CTA may aid in the preoperative identification of CNs, and when CNs are identified on CTA, CEA should be the preferred treatment over carotid artery stenting. Further studies are warranted to clarify the diagnostic criteria and treatment strategies for CNs in carotid disease.