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Ultrasonographical, Radiological and Pathological Correlation of a Floating Thrombus in the Common Carotid Artery

A 69-year-old patient developed aphasic signs and slight right ataxic hemiparesis consistent with a left hemispheric stroke. MRI revealed acute ischemic infarction in the left centrum semiovale. Cervical angio-MRI showed an occlusion of the left common carotid artery (CCA) (fig. 1a). Cervical ultrasound revealed an isoechoic pulsating mass throughout the left CCA (fig. 1b), suggesting a mobile thrombus. The patient underwent emergency thrombendarterectomy (fig. 1c); histologic examination confirmed local atherosclerotic changes with an inflammatory reaction (complicated plaque). Clinical evolution was favorable. According to the literature, even though cardioembolism may account for CCA thrombosis [1], most cases, including the present one, are due to local atheromatosis [2]. In acute stroke, detection of an occluded CCA on angio-MRI should lead to a rapid search for mobile thrombus by cervical ultrasound, in order to prevent potentially deleterious complications.