Atherosclerotic Plaque at the Carotid Bifurcation: CT Angiographic Appearance with Histopathologic Correlation
T. Barry Olivera,
G. Alistair Lammiea,
Andrew R. Wrighta,
Joanna Wardlawa,
Sandi G. Patela,
Russell Peeka,
C. Vaughan Ruckleya and
Donald A. Collie,a
a From the Departments of Neuroradiology (T.B.O., A.R.W., J.W., S.G.P., D.A.C.) and Neuropathology (G.A.L., R.P.), Western General Hospital, Edinburgh; and the Department of Vascular Surgery, Royal Infirmary of Edinburgh (C.V.R.), Scotland.
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FIG 1. Low-density plaque.
A, CT angiogram of internal carotid artery 1 cm above the bifurcation shows a severe stenosis (black arrow indicates contrast in lumen) caused by a large eccentric hypodense plaque (white arrowheads). The small area of calcification (open arrow) was not detected on the histologic section.
B, Corresponding histologic section shows a large necrotic core (N). The fibrous cap is intact at this level but of variable thickness; at O, it is thinned, and higher power showed superficial inflammation. S indicates the site of surgical incision.
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FIG 2. Mixed-density plaque.
A, CT angiogram of the proximal internal carotid artery shows a predominantly intermediate-density plaque with foci of hypodensity (arrowheads). Curved arrow indicates internal jugular vein.
B, Corresponding histologic section shows an irregular slitlike lumen (Lu) separated by a reasonably thick fibrous cap (C) from a large necrotic core (N) comprising necrotic and lipid debris as well as thrombus. S indicates surgical incision.
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FIG 3. Plaque ulceration.
A, CT angiogram of the common carotid artery 1 cm below the bifurcation shows circumferential arterial wall thickening, with a focal contrast-containing defect interpreted as an ulcer (arrow).
B, Corresponding histologic section shows a ruptured fibrous cap (C) with a mixture of necrotic debris (A) and thrombus (T) projecting into the lumen (Lu).
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