Fig 2. A 65-year-old woman with TIA. Ulcerated plaque of the left internal carotid artery (ICA); the typical button-of-shirt morphology is visible. Axial scan (A) illustrates ulcerations in a mixed plaque and displays a dissectionlike aspect. VR (B, C) clearly depicts the ulceration. Gross anatomic inspection confirms the presence of the ulcer (D). In this patient, the plaque is heavily calcified proximally and is not calcified at the location of the ulcer. This ulcer is distal to the point of maximum stenosis located in the bifurcation (80% NASCET), and could also have been a pseudoaneurysm from carotid dissection, but the surgical specimen confirmed the presence of ulceration. Note the big plaque calcification located in the bulbus/bifurcation (yellow arrows, ulceration; blue arrows, maximum stenosis point; green arrow, ICA; blue arrowhead, calcified plaque). The external carotid artery ostium is not visible because the cut plane passed through it.