ABSTRACT
Ultrasound (US) is one of the most important diagnostic tools available for the detection and evaluation of carotid stenosis. The case of a 70-year-old woman with recurrent right-sided amaurosis fugax presented here highlights the way in which tissue Doppler imaging (TDI) and contrast-enhanced US (CEUS) may aid in the diagnosis of carotid plaque vulnerability. Furthermore, the novel inverse fly-through technique was used for the three-dimensional visualization of the carotid stenosis.
ABSTRACT
A 62-year-old man was admitted after recurrent transient left-sided weakness and sensory loss. Ultrasound (US) examination revealed a 70% narrowing of the right proximal internal carotid artery (ICA). Contrast-enhanced US suggested plaque neovascularization (figure, A). Carotid endarterectomy of the right ICA was performed. Immunohistochemistry of the specimen showed, corresponding to the US findings, extensive plaque neovascularization associated with dense macrophage infiltration (figure, B, C). Plaque neovascularization is associated with inflammation and plaque progression.(1) The detection of plaque neovascularization by contrast-enhanced US could give further evidence of plaque vulnerability, but further study is needed to determine its value.