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“Snake Fang” Sign without Carotid Stenosis on Duplex Ultrasonography Indicates High Risk of Artery‐to‐Artery Embolic Stroke
Author(s) -
Tateishi Yohei,
Tsujino Akira,
Hamabe Jumpei,
Tasaki Osamu,
Morikawa Minoru,
Hayashi Tomayoshi,
Horie Nobutaka,
Hayashi Kentaro,
Suyama Kazuhiko,
Nagata Izumi
Publication year - 2012
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2012.00764.x
Subject(s) - medicine , stenosis , radiology , embolism , duplex ultrasonography , stroke (engine) , internal carotid artery , artery , cardiology , ultrasonography , mechanical engineering , engineering
BACKGROUND AND PURPOSE Artery‐to‐artery embolism generally occurs in patients with not only moderate to severe arterial stenosis but also plaque vulnerability. Two unique cases with free‐floating thrombi at the distal side of the small plaque in the internal carotid artery without stenosis are presented and its clinical implications are discussed. RESULTS Two middle‐aged men suffered embolic stroke. Initial duplex ultrasonography revealed small plaques and vortex flow without significant stenosis or plaque vulnerability in their internal carotid arteries. Continuous examination by duplex ultrasonography showed that free‐floating thrombi developed and regressed at the distal side of the small plaques. Histological examination disclosed plaque erosion at the distal side of the plaques without lipid core rupture. CONCLUSIONS In these two cases, duplex ultrasonography revealed free‐floating thrombi developed at the distal region of small plaques. Aggressive treatment should be considered in a patient with thromboembolic stroke who has the small plaque presenting “snake fang” sign even if there is no stenosis or plaque vulnerability.