Interact CardioVasc Thorac Surg 2009;8:496-497. doi:10.1510/icvts.2008.198754
© 2009 European Association of Cardio-Thoracic Surgery
Case report - Carotid and imaging |
Mobile floating carotid plaque post-trauma. Diagnosis and treatment
Emanuele Ferrero*,
Andrea Gaggiano,
Michelangelo Ferri and
Franco Nessi
Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Largo Turati 62, 10128 Turin, Italy
Received 19 November 2008;
received in revised form 26 December 2008;
accepted 30 December 2008
*Corresponding author. Tel.: +39-11-5082605; fax: +39-11-5082606.
E-mail address: emaferrero{at}libero.it (E. Ferrero).
 |
Abstract
|
|---|
We report the cases of two patients with mobile floating carotid plaques (MFCP). Two men were referred to us for carotid investigation after trauma. The duplex ultrasonography scan (DUS) showed the presence of a mobile floating plaque into the internal carotid artery associated with a stenosis of 40% and 65%, respectively (ECST criteria). Both patients were asymptomatic. Early CEA was performed (<24 h after admission). Intraoperatively it was confirmed the presence of MFCP. The patients were discharged without neurological symptoms two days postoperatively. At the follow-up the DUS showed the patency of the CEA without restenosis or residual flap.
Key Words: Mobile floating carotid plaque; Carotid endoarteriectomy; Duplex scan
|
1. Manuscript
|
|---|
The mobile floating carotid plaque (MFCP) is an uncommon pathology with a low incidence and a high risk of embolic cerebrovascular diseases. MFCP differs from floating thrombus in carotid artery because in this case it is the atheromasic plaque that is mobile. The natural history of this lesion is unknown. We report the cases of two patients with mobile carotid plaques diagnosed in two different periods of time (the first one in 2006 and the second one in 2008). Two men (69 and 70-year-old) were referred to our unit from another regional hospital, for carotid investigation after trauma. Both patients were admitted to our vascular unit after a recent trauma, subsequent to an episode of syncope (one patient had been involved in a car crash and the other one had fallen from a tree). In one patient a post-traumatic fracture of the cervical vertebrae (C6) was diagnosed. The brain computed tomography (CT) scan was negative in both patients. We performed a duplex ultrasonography scan (DUS) which showed the presence of a 0.76 cm long mobile floating plaque in the left internal carotid artery (ICA, Fig. 1; Video 1), associated with a stenosis of 30–40% in the left carotid bulb (ECST criteria) in one case, and the presence of a 0.83 cm long MFCP, in the right ICA associated with a stenosis of 60–65% in the right carotid bulb (ECST criteria) in the other case. Both patients were asymptomatic and early CEA was performed (<24 h after admission). In one patient the eversion technique under general anaesthesia was performed while the second patient was scheduled for a standard technique under local anaesthesia. Intraoperatively it was confirmed the presence of MFCP (Fig. 2). The intraoperative DUS showed the good result of surgery without residual flaps or stenosis. In both cases the patients were discharged in good general conditions without neurological symptoms two days postoperatively. One patient was followed-up with DUS after 6, 12 and 24 months, the other one after 6 months. In both cases the duplex scan showed the patency of the CEA without evidence of restenosis or residual flap. To our knowledge in literature there are few cases describing the presence of MFCP. The natural history of these lesions is unknown so the treatment still remains controversial. Escribano et al. [1] describe two cases of patients with mobile carotid plaques, one treated with CEA and one with medical therapy, both improved. Chakhtoura et al. [3] reported two cases of MFCP successfully treated with carotid artery stenting (CAS). Cho et al. [2] reported one case of free-floating atheromatous carotid plaque successfully treated with CEA. Urbano et al. [4] reported a case of a heterogeneous atheromatous plaque with interrupted fibrous cap at the origin of the right internal carotid artery that was treated with CEA because after 20 days, even if the patient was under anticoagulant treatment, presented a floating thrombus attached to the known plaque in the right ICA. Szendro et al. [5] studied two cases of MFCP in symptom-free patients treated with medical therapy (oral anticoagulants), where the two lesions spontaneously disappeared without any clinical sequel. We can assert that the DUS is a good method to assess and detect this carotid lesion, with high sensivity and specificity, in revealing MFCP (especially in B-mode) and that in our experience CEA was a good therapeutic method of treating MFCP. In both the cases we treated, the probable etiology of the MFPC was a trauma, subsequent to an episode of syncope. Even if established guidelines are not published for the management of MFCP, both surgical and medical treatments need further investigation. In conclusion, we can assert that in our experience early CEA for MFCP was a good way to manage and prevent plaque fragmentation or adhesion of floating thrombus, avoiding subsequent embolization and major hemispheric stroke.
|
References
|
|---|
- Escribano JM, Juan J, Rodríguez Mori A, Bellmunt S, Matas M. Mobile carotid plaque. Rev Neurol 2001, 1–15;33:836–839.[Medline]
- Cho YP, Kwon TW, Kim GE. Sonographic appearance of a free-floating atheromatous plaque in a patient with acute stroke. J Clin Ultrasound 2002;30:317–321.[CrossRef][Medline]
- Chakhtoura EY, Goldstein JE, Hobson RW. Management of mobile floating carotid plaque using carotid artery stenting. J Endovasc Ther 2003;10:653–656.[CrossRef][Medline]
- Urbano LA, Perren F, Rossetti AO, Von Segesser L, Bogousslavsky J, Devuyst G. Thrombus in the internal carotid artery complicating an ‘unstable’ atheromatous plaque. Circulation 2003;107:e19–e20.[CrossRef][Medline]
- Szendro G, Sabetai MM, Tegos TJ, Dhanjil S, Lennox AF, Nicolaides AN. Mobile carotid plaques: the natural history of two asymptomatic and non-operated cases. J Vasc Surg 1999;30:357–362.[CrossRef][Medline]
|
|
Top
Abstract
1. Manuscript
