Report of Two Cases of Adventitial Extension of Carotid Plaque in Carotid Endarterectomy: Usefulness of Preoperative Ultrasonic Evaluation

Abstract

We report two cases in which carotid endarterectomy was aborted because of the carotid plaque extending into the adventitia (outer layer of the artery). The medical team performed carotid artery stenting instead in both patients. A retrospective analysis of preoperative carotid artery ultrasonography revealed that the hypoechoic zone, usually found between the plaque and adventitia, was absent. In these cases, the plaque and adventitia appeared as a single continuous mass, suggesting that the plaque had infiltrated the adventitia. Although predicting adventitial carotid plaque extension remains challenging, careful attention to the hypoechoic zone on carotid ultrasonography may help to identify such pathological conditions before surgery.