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Liu W, Lu S, Feng Y, Zhang Z, Liu P, Liu Z. Truth of Floating Carotid Plaques. Front Neurol 2018; 8:673. [PMID: 29312114 PMCID: PMC5733059 DOI: 10.3389/fneur.2017.00673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 11/27/2017] [Indexed: 11/13/2022] Open
Abstract
The floating plaque in carotid artery is an uncommon condition that can be detected by a duplex ultrasonography scan and is a high-risk factor for embolic cerebrovascular disease. The histopathological features of floating plaque in carotid artery vary. To the best of our knowledge, there is still considerable controversy about the treatment of floating carotid plaque. In this case, the floating carotid plaque was located in the edge of atherosclerotic plaque in common carotid artery, pathological finding following carotid endarterectomy confirmed that the mobile substances were formed by the contents of the plaque protruding into the carotid lumen after the rupture of the fibrous cap, without mural thrombus. This pathological change was different from those of the mobile substances, which were commonly considered as mural thrombotic substances of ulcer plaque caused by the ruptures of fibrous cap of vulnerable plaque. According to pathological differences, we investigated pathogenesis of ischemic cerebrovascular disease caused by floating carotid plaque and possible treatments.
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Affiliation(s)
- Wei Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Shuo Lu
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Yibo Feng
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Zhiyong Zhang
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zunjing Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
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Muraki M, Mikami T, Yoshimoto T, Fujimoto S, Kitaguchi M, Kaga S, Sugawara T, Tokuda K, Kaneko S, Kashiwaba T. Sonographic Detection of Abnormal Plaque Motion of the Carotid Artery: Its Usefulness in Diagnosing High-Risk Lesions Ranging from Plaque Rupture to Ulcer Formation. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:358-364. [PMID: 26589531 DOI: 10.1016/j.ultrasmedbio.2015.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/18/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
We investigated the feasibility of using sonography of abnormal plaque motion to diagnose high-risk carotid lesions ranging from plaque rupture to ulcer formation. Fifty consecutive carotid arteries of 49 patients (71 ± 7 y, 37 males) who underwent carotid endarterectomy were investigated by carotid sonography to find a plaque concavity (sonographic ulcer [SU]), fine trembling motion inside the plaque (FTMI) and systolic retractive motion of the plaque surface (SRMS). Plaque rupture or ulcer, necrotic core and intra-plaque hemorrhage were determined at carotid endarterectomy. Twenty-two SUs, 41 cases of FTMI and 20 cases of SRMS were detected by carotid sonography. The sensitivity and specificity of SU in diagnosing plaque rupture or ulcer at carotid endarterectomy were 48% and 90%, and those of FTMI were 93% and 60%. Plaques with SRMS more frequently had both a necrotic core and intra-plaque hemorrhage than those without SRMS (80% vs. 30%, p = 0.0005). Abnormal plaque motion detected by carotid sonography is useful in detecting a ruptured or ulcerated plaque with a necrotic core and/or hemorrhage.
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Affiliation(s)
- Mutsuko Muraki
- Sonographic Laboratory, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
| | - Taisei Mikami
- Faculty of Health Sciences, Hokkaido University School of Medicine, Sapporo, Japan.
| | | | - Shin Fujimoto
- Department of Neurosurgery, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
| | - Mayumi Kitaguchi
- Sonographic Laboratory, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
| | - Sanae Kaga
- Faculty of Health Sciences, Hokkaido University School of Medicine, Sapporo, Japan
| | - Tomoko Sugawara
- Department of Cardiovascular Medicine, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
| | - Kouichi Tokuda
- Department of Neurosurgery, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
| | - Sadao Kaneko
- Department of Neurosurgery, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
| | - Takeshi Kashiwaba
- Department of Neurosurgery, Kashiwaba Neurosurgery Hospital, Sapporo, Japan
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Lim SN, Chang YJ, Lin SK. Extracranial Carotid Artery Disease: Risk Factors and Outcomes in Patients With Acute Critical Hemispheric Ischemic Stroke. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:341-348. [PMID: 26764275 DOI: 10.7863/ultra.15.03070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/03/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The prevalence of carotid disease in stroke patients has been underestimated because most stroke patients who receive carotid sonography have already survived the acute event. Little is known about the extracranial carotid arteries of patients with acute stroke who need intensive care. This study reviewed color-coded carotid duplex sonographic examinations of the extracranial carotid arteries of patients with acute critical hemispheric ischemic stroke. METHODS We retrospectively reviewed 30 consecutive patients who had acute critical hemispheric ischemic stroke and received color-coded carotid duplex sonography in the intensive care unit. The presence of occlusive carotid artery disease was correlated with clinical features, vascular risk factors, and outcomes. RESULTS Overall, 57% of the patients (17 of 30) had an occlusive internal carotid artery, and 44% of patients with atrial fibrillation (7 of 16) also had occlusive carotid disease. Eventually, 73% of the patients (21 of 30) had poor outcomes, and 57% (17 of 30) died. The contributing factors to a poor outcome were older age, an initial conscious disturbance, endotracheal intubation, and occlusive carotid disease, with the most significant factor being older age (P = .022; odds ratio, 27.76). The factors contributing to death were endotracheal intubation, occlusive carotid disease, and reversed ophthalmic flow, with the most significant factor being occlusive carotid disease (P = .014; odds ratio, 11.38). Soft homogeneously echogenic thrombi filling the lumen of the internal carotid artery and moving forward and backward with the carotid pulse were found in 3 patients. A small segment of ruptured plaque that was floating forward and backward with pulsation was found in 1 patient. CONCLUSIONS Occlusive carotid artery disease is not uncommon among Chinese patients who have had an acute critical hemispheric infarction. Older age is the factor most significantly correlated with a poor outcome, and occlusive carotid disease is the factor most significantly correlated with death.
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Affiliation(s)
- Siew-Na Lim
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan (S.-N.L., Y.-J.C.); Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan (S.-K.L.); and School of Medicine, Tzu Chi University, Hualien, Taiwan (S.-K.L.)
| | - Yeu-Jhy Chang
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan (S.-N.L., Y.-J.C.); Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan (S.-K.L.); and School of Medicine, Tzu Chi University, Hualien, Taiwan (S.-K.L.)
| | - Shinn-Kuang Lin
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan (S.-N.L., Y.-J.C.); Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan (S.-K.L.); and School of Medicine, Tzu Chi University, Hualien, Taiwan (S.-K.L.).
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Discrepancy Between Duplex Sonography and Digital Subtraction Angiography When Investigating Extra- and Intracranial Ulcerated Plaque. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Delgado MG, Vega P, Roger R, Bogousslavsky J. Floating thrombus as a marker of unstable atheromatous carotid plaque. Ann Vasc Surg 2011; 25:1142.e11-7. [PMID: 22023953 DOI: 10.1016/j.avsg.2011.05.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 04/13/2011] [Accepted: 05/27/2011] [Indexed: 10/16/2022]
Abstract
Floating thrombus in a carotid artery is an uncommon pathology with a high risk of embolism. We present three patients diagnosed with acute stroke, with a floating thrombus complicating an atheromatous plaque, who were treated with anticoagulants and statins. Although two patients had satisfactory results, one patient suffered a stroke related to plaque progression nearly 3 years after initial presentation. Medical treatment seems to be a good initial option, although late cerebral ischemic complications may be seen due to carotid plaque instability. Delayed carotid endarterectomy or stenting should be considered in cases with subsequent plaque progression.
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Affiliation(s)
- Montserrat G Delgado
- Neurology and Radiology Service, Hospital Universitario Central de Asturias, Oviedo, Spain.
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Khurana D, Saini M, Laldinpuii J, Khandelwal N, Prabhakar S. Mobile plaque in the internal carotid artery: A case report and review. Ann Indian Acad Neurol 2011; 12:185-7. [PMID: 20174501 PMCID: PMC2824937 DOI: 10.4103/0972-2327.56320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 05/16/2008] [Accepted: 05/25/2008] [Indexed: 11/06/2022] Open
Abstract
A mobile plaque in the carotid artery is an uncommon entity, usually detected incidentally on a carotid duplex scan or angiography. It is associated with an indeterminate risk of an embolic stroke and should be managed on an emergent basis. We report here a case of a mobile plaque in the internal carotid artery that was detected serendipitously in a carotid duplex scan.
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Affiliation(s)
- Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India
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Funaki T, Iihara K, Miyamoto S, Nagatsuka K, Hishikawa T, Ishibashi-Ueda H. Histologic characterization of mobile and nonmobile carotid plaques detected with ultrasound imaging. J Vasc Surg 2011; 53:977-83. [DOI: 10.1016/j.jvs.2010.10.105] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 10/15/2010] [Accepted: 10/18/2010] [Indexed: 11/17/2022]
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Nakajima M, Yasaka M, Minematsu K. Mobile Thrombus from a Ruptured Plaque in the Brachiocephalic Artery. J Stroke Cerebrovasc Dis 2008; 17:423-5. [DOI: 10.1016/j.jstrokecerebrovasdis.2008.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 03/13/2008] [Accepted: 04/07/2008] [Indexed: 11/30/2022] Open
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Bhatti AF, Leon LR, Labropoulos N, Rubinas TL, Rodriguez H, Kalman PG, Schneck M, Psalms SB, Biller J. Free-floating thrombus of the carotid artery: Literature review and case reports. J Vasc Surg 2007; 45:199-205. [PMID: 17210411 DOI: 10.1016/j.jvs.2006.09.057] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Accepted: 09/28/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND Free-floating thrombus (FFT) of the carotid artery is an uncommon entity that usually presents as an acute emergency. Management is based on case reports and series because the natural history and optimal treatment are unknown. This study was conducted to systematically review the world literature in an attempt to better understand FFT, its presentation, distribution, management, and outcome. METHOD A literature search in all languages was performed of the PubMed database (> or =1950s) and Medline database (1966-November 2004). All relevant articles were reviewed and their references analyzed in a similar manner for further literature. Cases from the authors' institutions were reviewed as well. All cases within the reports were individually assessed for inclusion or exclusion. Inclusion required that the FFT originate or anchor within the carotid artery (ie, excluding emboli, arch thrombi with extensions into the carotid artery), be partially occluding (ie, excluding occlusions, "string-sign," microscopic thrombus), and ideally have an elongated or protrusive morphology, circumferential flow around the distal portion, and cyclical motion with the cardiac cycles. RESULTS There were 61 reports reviewed, of which 43 contained FFT cases. These reports had 342 cases (including the current series) that were reviewed, of which 145 met our inclusion criteria. A database was created for qualitative and quantitative assessment of all cases. When data were pooled, appropriate statistical analysis was performed. A limitation of the study is that FFT is under-reported and ill defined, which limited the analysis in quantity and quality. In addition, reporting is not uniform, and therefore, significant data were not always present. In attempting to define FFT and include or exclude cases, subjectivity is inherent. CONCLUSIONS FFT is more frequently reported in men than women, with a ratio of nearly 2:1 (P < .0001), and at a younger age than in most patients with carotid disease (P < .0001 when compared with North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and Asymptomatic Carotid Surgery Trial). Symptoms are present in 92% of patients. There was a trend for patients with FFT to be hypercoagulable (47% of those serologically tested). The internal carotid artery was the most commonly affected (75%), with atherosclerosis being the most common associated pathology. Medical and surgical management have both been used, with neither clearly superior to the other. Medical management for stabilizing neurologic deficits has less risk and less benefit than surgical intervention.
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Affiliation(s)
- Ahmad F Bhatti
- Department of Vascular Surgery, Loyola University Medical Center, Maywood, IL 60153-3304, USA.
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Chakhtoura EY, Goldstein JE, Hobson RW. Management of mobile floating carotid plaque using carotid artery stenting. J Endovasc Ther 2003; 10:653-6. [PMID: 12932182 DOI: 10.1177/152660280301000336] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To present management techniques for dealing with mobile floating carotid plaque (MFCP), which represents an indeterminate risk of embolic cerebrovascular events. CASE REPORTS Two high-risk patients with a history of carotid endarterectomy were diagnosed with MFCP by duplex ultrasound scanning. One patient had a left hemispheric transient ischemic attack while the other was asymptomatic with a moderate stenosis. Both were successfully treated with carotid artery stenting, achieving complete coverage of the MFCP. Their outcomes were uneventful, and sustained patency of the stented arteries has been observed during an event-free survival of 32 and 44 months, respectively. CONCLUSIONS Based upon the unique nature of these lesions and our satisfactory clinical results, we believe that carotid stenting may be a viable option for the treatment of MFCP.
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Affiliation(s)
- Elie Y Chakhtoura
- Division of Cardiology, St. Michael's Medical Center, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, USA
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Chakhtoura EY, Goldstein JE, Hobson RW. Management of Mobile Floating Carotid Plaque Using Carotid Artery Stenting. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0653:momfcp>2.0.co;2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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