A 58-year-old woman presented 1 week after a single episode of left-eye blindness that lasted 30 seconds. It spontaneously resolved, and she had no further visual disturbances. She denies weakness, numbness, paralysis, paresthesias, speech disturbance, or gait disturbance. A carotid duplex ultrasound suggested a less than 50% left internal carotid artery (ICA) stenosis, but there was a suggestion of a complex plaque. Further imaging with computed tomography (CT) angiography was performed, and showed a left ICA eccentric, ulcerative complex plaque not associated with a significant stenosis.
While degree of carotid stenosis is related to stroke risk, plaque morphology may also play a role.
Increased risk for neurologic events is seen in patients with less organized, soft, echolucent, complex, or ulcerated plaque, regardless of the degree of stenosis. Plaque that is echolucent, heterogeneous, and ulcerated, and has a high lipid content core may be more unstable and prone to rupture with embolization.1
Intraplaque hemorrhage, or plaque with thin or ruptured fibrous caps, may also present a higher stroke risk (Figure 23-1).
