Thrombus-like floating mass associated with cervical carotid plaque

We have diagnosed the extremely fragile plaque as motion of the plaque content, and have reported their clinical characteristics and therapeutic importance. A floating mass associated with motion of plaque content could also potentially cause an embolic stroke. However, the origin and pathogenesis of such floating masses have not yet been clarified. We have experienced five cases of patients who had symptoms of CVA and underwent pathological examination following carotid endarterectomy. The floating mass dominantly existed at the distal part of the plaque and was pathologically consistent with thrombus. The relation of hemostasis as well as the existence of a thrombotic core, in addition to the damaged surface membrane of the plaque, was suspected to play an important role in the mechanism of disease in such cases. Such abnormal hemodynamics could result in embolic stroke and should be treated surgically and as soon as possible.