The True Shape of a Vulnerable Carotid Plaque

An 81 year old man was referred to the Emergency Department with transient dysarthria. Computed tomography angiography of the supra-aortic vessels showed severe stenosis of the left internal carotid artery with vulnerable plaque (A, red arrow). High dose statin and antiplatelet therapy was commenced. A surgical carotid endarterectomy was performed seven days later. Macroscopic examination of the plaque revealed disruption of its inner layer with “holes”, which were possibly the source of emboli (B, black arrow). The post-operative period was uneventful. This image underlines the strict correlation between vulnerable plaque and neurological events.