Purpose: Jellyfish plaque is defined as “the entire plaque surface or a part of the surface deforms with arterial pulsation”. This study was aimed to clarify the relationship between movement of jellyfish plaque and pulsatile blood flow.
Methods: We performed carotid ultrasonography for 502 patients with cervical carotid stenosis from November 2016 to March 2020. A total of 38 patients with jellyfish plaque was detected. Among them, we evaluated jellyfish plaque of 26 lesions in 22 patients (22 males, median age: 76 years old ranging 60–86), who were able to simultaneously record B-mode and pulsed-wave Doppler imaging (PWD), were retrospectively verified. Sample volume was set in the blood vessel lumen near jellyfish plaque, and B-mode and PWD were simultaneously recorded. Phase of the plaque surface movement (i.e. ups and downs) was analyzed by the waveform of the blood flow in PWD.
Results and Discussion: All subjects demonstrated the plaque surface movement as lowest in the peak of systolic velocity through highest in the end of diastolic velocity.
Conclusion: Arterial pulsation was presumed to influence on the movement of jellyfish plaque surface. To refer arterial beat and periodical plaque movement would help identify this fragile type of plaques.

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A 47-year-old woman under anti-cancer therapy for stage IV breast cancer visited our hospital for unsteadiness of gait, vertigo, and malaise, although MRI showed no abnormal findings. Three days later, she was taken to the emergency room by ambulance since she was vomiting and scarcely moving. On admission, neurological examination revealed only vertigo, and NIHSS score was 0. Laboratory examination showed slightly increasing D-dimer and elevated CA15-3 and BCA225 levels. Since MRI showed a hyperintense area in the cerebellum, she was hospitalized under the suspicion of cancer-related stroke. Enhanced CT showed no deep vein thrombosis, and transesophageal echocardiography, transthoracic echocardiography, and carotid ultrasonography did not indicate an embolic source. However, transcranial color flow imaging (TC-CFI) showed 40 microembolic signals (MES) in the basilar artery (BA) for three minutes, with no MES in the middle cerebral artery (MCA). Despite the risk of hemorrhagic transformation, heparin was started on the six day of admission. Thereafter, MRI showed no recurrence, and MES was not seen in both the MCA and BA by TC-CFI. In this case, MES decreased significantly after heparin treatment, as indicated by TC-CFI, suggesting that MES detection by TC-CFI was useful for understanding the morbid state of cancer-related stroke.

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