Carotid endarterectomy for mild carotid stenosis with recurrent cerebral infarction

Abstract

A 67-year-old woman was admitted to our hospital, presenting with left hemiparesis. She had a history of old cerebral infarction and epilepsy. Brain magnetic resonance imaging (MRI) revealed acute infarction in the right frontal lobe. Cerebral angiography showed a mild stenotic lesion (NASCET 42%) in the origin of the right carotid artery. Ulceration was not obviously detected by angiographic image or ultrasonography. Despite antithrombotic treatment, cerebral infarction recurred in the right frontal lobe 81 days after the admission day of the first hospitalization. Contrast-enhanced ultrasonography revealed the plaque ulceration in the right carotid artery. A black-blood-MR T1-weighted image showed high-intensity signal in the right carotid artery, suggesting unstable plaque. Carotid endarterectomy was performed to prevent ischemic stroke recurrence. The patient had no perioperative complication or recurrent stroke. A carotid endarterectomy may be an effective therapeutic strategy for patients with symptomatic mild carotid artery stenosis who have carotid plaque ulceration and contrast-enhanced ultrasonography is useful to detect it.