Ulcerated Atheromatous Plaques of the Carotid Artery Bifurcation

The clinical diagnosis of an ulcerated plaque at the bifurcation of the common carotid artery is based on: mid-carotid bruit, cholesterol or platelet emboli in the retina, transient ischemic attacks particularly with amaurosis fugax, and a reversible neurological deficit. In this series, thrombosis in situ was the final phenomenon in the natural history of the ulcerated plaque. In certain unusual instances it appears that the pathogenesis of a transient ischemic attack is a decrease in cardiac output (fall in systemic blood pressure) leading to a disproportionate decrease in cerebral blood flow in that portion of the arterial system distal to a pathologically narrowed artery. The ultimate diagnosis of an ulcerated plaque depends upon the radiological description at arteriography and upon direct visualization by the surgeon. Surgical treatment at the present time is the therapy of choice. Ulcerated carotid plaques may be bilateral, and, occasionally, are found at other levels than the bifurcation of the common carotid; however, ulcerated plaques were not seen in the intracranial vessels.