Introduction. Although intervention in patients with symptomatic carotid
disease is generally accepted as beneficial, the management of asymptomatic
disease is still controversial. We wanted to introduce and discuss treatment
options in a patient with asymptomatic carotid stenosis and high embolic
potential lesions of common and internal carotid artery detected by
multidetector computed tomography (MDCT). Case Outline. A 78-year-old female
patient was admitted to our institution for diagnostics and surgical
treatment of asymptomatic high-grade carotid stenosis. Upon admission, color
duplex ultrasonography of the carotid arteries revealed the left common
carotid artery (CCA) stenosis of 50% and the ipsilateral internal carotid
artery (ICA) stenosis of 60%, while the right CCA was narrowed by 60% and the
ipsilateral ICA by 80%. Because of the left subclavian artery (LSA)
occlusion, also described by ultrasonography, MDCT angiography was performed
to assess arterial morphology for possible angioplasty. In addition to LSA
occlusion, MDCT angiography surprisingly revealed significant left CCA (>80%)
and ICA (>70%) narrowing by ulcerated plaques with high embolic potential.
Surgical treatment of the left CCA and ICA was indicated and Dacron? tubular
graft interposition was performed. The postoperative course was uneventful
and the patient was discharged from the Institute on the third postoperative
day. After the six-month follow-up the patient was doing well with
well-preserved graft patency. Conclusion. Although color duplex
ultrasonography is reliable and safe imaging modality in carotid stenosis
diagnosis, MDCT angiography plays a significant role in patients with
asymptomatic carotid stenosis since plaques with high embolic potential could
be detected, which, if left untreated, could have severe neurological
ischemic consequences.
Is it possible that this patient is asymptomatic? The role of multidetector ct angiography in detection of ulcerated plaques in patients with asymptomatic carotid stenosis: Case report
