Shrinkage of carotid plaque in a patient with transient ischemic attack]

A 65-year-old man visited to our hospital, because he felt dull pain on the right side of the neck and had transient weakness of the left hand repeatedly. Carotid ultrasonography revealed a large plaque with severe stenosis and ulceration at the bifurcation of right common carotid artery. The plaque was mostly hypoechoic and only the basal part was hyperechoic. Magnetic resonance (MR) study showed multiple high-intensity spots in superficial borderzone area of the right cerebral hemisphere on fluid attenuated inversion recovery images, although diffusion-weighted images revealed no abnormality. Intracranial stenotic lesion was not detected by MR angiography. We diagnosed transient ischemic attacks due to right carotid artery stenosis. Nine days after the symptom onset, he showed no signs of cerebral ischemic attacks and seven days later he began taking aspirin and remained stable. Three months later, carotid ultrasonography showed marked shrinkage of the carotid plaque, of which hypoechoic part virtually disappeared. Release of the atheroma gruel and/or intraplaque hemorrhage due to plaque rupture might lead to dramatic change of the carotid plaque.