A Case of Symptomatic Intraluminal Internal Carotid Artery Thrombus in a Patient with Essential Thrombocythemia Surgically Treated by CEA

Figure 1

Imaging Findings. (A, B) Magnetic resonance diffusion-weighted images obtained at admission. Scattered subacute-phase cerebral infarction in the right hemisphere. (C, D) 3D computed tomography angiography showed high-grade stenosis of the right internal carotid artery. (E) A translucent lesion is recognized in the right internal carotid artery on cerebral angiography and diagnosed as an internal carotid artery floating thrombus. (F–H) Carotid plaque image. Sagittal (F) T2 axial. (G) T1 position. (H) T1 shortening is absent, suggesting that time has elapsed since thrombus formation. (I, J) Initial cervical magnetic resonance angiography (MRA) after admission (I) and cervical MRA after three weeks of antithrombotic therapy (J). (K) Intraoperative carotid endarterectomy (CEA) findings. It did not differ from conventional CEA except for an impression of slightly more bleeding. (L) Carotid artery internal thrombus removed per plaque. A white thrombus is also observed. (M, N) Magnetic resonance imaging as seen 2 days after surgery. No obvious new cerebral infarction was observed (M), and carotid artery stenosis was confirmed to have been released (N).