A 66-year-old man with cryptogenic ischemic stroke and multiple acute ischemic lesions in the right middle cerebral artery territory was enrolled in the CAPIAS trial (Carotid Plaque Imaging in Acute Stroke; NCT01284933). Baseline carotid MRI demonstrated a right-sided nonstenotic American Heart Association type-VI plaque with a large lipid/necrotic core and intraplaque hemorrhage (figure 1). Eleven months later, the patient presented again after an episode of right eye amaurosis fugax. Repeat carotid MRI revealed a new ulceration on the right side with large parts of the former lipid/necrotic core missing (figure 2). We hypothesize that plaque rupture had caused embolization into the right retinal artery.
Baseline carotid MRI demonstrating a complicated American Heart Association type-VI plaque of the right internal carotid artery (*). High signal on time-of-flight (TOF) and T1-weighted images (arrow) corresponding to intraplaque hemorrhage within a large lipid/necrotic core. PD = proton density; 3D = 3-dimensional.
At repeat MRI, this plaque showed profound superficial irregularities, with a new ulceration and parts of the former lipid/necrotic core missing (arrowhead). PD = proton density; TOF = time of flight.
Footnotes
Author contributions: Florian Schwarz: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, contribution of vital reagents/tools/patients, acquisition of data. Anna Bayer-Karpinska: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, acquisition of data. Holger Poppert: drafting/revising the manuscript. Martin Buchholz: drafting/revising the manuscript, analysis or interpretation of data, acquisition of data. Clemens Cyran: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, acquisition of data, study supervision. Jochen Grimm: drafting/revising the manuscript, analysis or interpretation of data, acquisition of data. Andreas Helck: analysis or interpretation of data, acquisition of data. Konstantin Nikolaou: drafting/revising the manuscript, study concept or design, study supervision. Christian Opherk: analysis or interpretation of data, acquisition of data, study supervision. Martin Dichgans: drafting/revising the manuscript, analysis or interpretation of data, acquisition of data. Tobias Saam: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, acquisition of data, study supervision.
Study funding: No targeted funding reported.
Disclosure: F. Schwarz and A. Bayer-Karpinska report no disclosures. H. Poppert has received speaker honoraria from Bayer Schering Pharma, Roche, Boehringer Ingelheim, ev3, and Novartis and receives research support from BMWi and Deutsche Stiftung Neurologie. M. Buchholz, C. Cyran, J. Grimm, and A. Helck report no disclosures. K. Nikolaou has served on a scientific advisory board for Bayer Schering Pharma; serves as Cardiac Section Editor for European Radiology; receives royalties from the publication of Multislice CT, 3rd edition (Springer, 2005); and serves on speakers' bureaus for and has received speaker honoraria from Bayer Schering Pharma, Bracco, and Siemens Medical Solutions. C. Opherk receives research support from the Deutsche Forschungsgemeinschaft and the Dr. Werner Jackstädt Foundation; has served on scientific advisory boards for Boehringer-Ingelheim and Bristol-Myers Squibb; and has received speaker honoraria from Boehringer-Ingelheim. M. Dichgans receives research support from BMB, NGFNPlus, Wellcome Trust, and the Foundation for Vascular Dementia Research. T. Saam receives research support from Bayer Schering Pharma and Diamed Medizintechnik. Go to Neurology.org for full disclosures.
- © 2013 American Academy of Neurology
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