The detection of carotid plaque rupture caused by intraplaque hemorrhage by serial high-resolution magnetic resonance imaging: a case report

Abstract

Background: Plaque rupture is believed to be a critical event that leads to thromboembolic complications in atherosclerotic carotid artery disease. Intraplaque hemorrhage can also cause fibrous cap disruption and may be related to the progression of atherosclerosis. However, the mechanism that leads to fibrous cap disruption is not well defined, and there have been few reports in the literature that carotid plaque rupture could be clearly visualized by serial high-resolution MRI.

Case description: We describe a case of a 79-year-old man who presented with minor ischemic stroke. On diffusion-weighted image, new multiple embolic spots were detected. Plaque rupture caused by intraplaque hemorrhage could be clearly detected by serial high-resolution MRI of the cervical carotid artery. The patient underwent carotid endarterectomy, and an atheromatous plaque was extracted intact for histologic analysis. In the histologic section corresponding to the MRI slices, plaque rupture caused by intraplaque hemorrhage was demonstrated.

Conclusions: This case represents a valuable example of artery-to-artery embolisms from a carotid plaque rupture secondary to intraplaque hemorrhage. High-resolution MRI may have important applications in natural history studies and in clinical trials of carotid plaques.