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Case series
Asymptomatic moderate carotid artery stenosis with intraplaque hemorrhage: onset of new ischemic stroke
  1. Kiyofumi Yamada1,
  2. Masanori Kawasaki3,
  3. Shinichi Yoshimura4,
  4. Yuichi Sasaki1,
  5. Shigehiro Nakahara1,
  6. Yoshikazu Sato2
  1. 1Department of Neurosurgery, Sato Daiichi Hospital, Oita, Japan
  2. 2Department of Radiology, Sato Daiichi Hospital, Oita, Japan
  3. 3Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan
  4. 4Department of Neurosurgery, Hyogo College of Medicine, Hyogo, Japan
  1. Correspondence to Dr Kiyofumi Yamada, Department of Neurosurgery, Sato Daiichi Hospital, 77-1 Hokyoji, Usa, Oita 879-0454, Japan; yamadakiyofumi{at}gmail.com

Abstract

Background The degree of stenosis of carotid arteries is recognized as an important risk factor for ischemic stroke. However, high-grade stenosis does not always cause cerebrovascular events, whereas low- to moderate-grade stenosis may often cause strokes. It has been reported that there is an association between carotid intraplaque hemorrhage (IPH) and new brain ischemic events.

Case presentation We present three patients with asymptomatic moderate carotid artery stenosis and carotid IPH who underwent both neurological and MRI at baseline and after at least 1 year's follow-up. These patients were admitted to our hospital (after 15–35 months of follow-up) because of neurological deficits. Diffusion-weighted MRI of the brain showed ipsilateral new ischemic lesions due to carotid artery plaques. The patients were treated with carotid artery stenting and discharged uneventfully.

Conclusions Whether plaques with severe stenosis already had severe stenosis at the onset of events or plaques with moderate stenosis progressed owing to an acute change, such as growth of an IPH, remains unclear, because no carotid imaging was carried out just before the events. This is the first case report which presents neurological symptoms and MRI at both baseline and follow-up in patients with asymptomatic moderate carotid artery stenosis and carotid IPH.

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