An interesting case suggesting a correction of intra-plaque neovascularization and plaque protrusion in carotid artery stenting

A 79-year-old man was admitted to our hospital because of mild right hemiparesis and was diagnosed with cerebral infarction caused by left internal carotid artery stenosis. He was treated with dual antiplatelet therapy. The preoperative left carotid angiogram showed 95% stenosis by the NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria. Carotid artery stenting (CAS) was performed on 21 days after onset. The postoperative carotid ultrasound showed findings of protrusion in the stent. On the mode of color-Doppler, clear delineation of this structure was not possible due to the color blurs in the stent. On the other hand, superb micro-vascular imaging (SMI) clearly demonstrated the protrusion and the neovascularization in the plaque excluded by the stent. The present case suggests that intraplaque neovascularization might be associated with plaque protrusion in CAS.