Rare Case of Floating Intimal Flap Associated with Atheromatous Carotid Plaque

A Patient with Carotid Mobile Plaques Treated by Carotid Artery Stenting Using a Double-layer Micromesh Stent

“…Several cases of plaque regression achieved by medical treatment alone including oral antithrombotic drugs have been reported 12,13) ; however, mobile plaques are accompanied by a pathologically degenerated arteriosclerotic flap, and ruptured plaques are accompanied by a mobile thrombus, intimal dissection, thin or defective fibrous capsule, lipid-rich necrotic core, and hemorrhage, and have been treated by CEA in many cases. [2][3][4][5]14,15) However, CAS may be a treatment choice for carotid artery stenosis patients with a past medical history specified as a risk factor for CEA in the stenting and angioplasty with protection in patients at a high risk for endarterectomy, 16) mobile plaques accompanied by clinically significant cardiac disease, severe pulmonary disease, contralateral carotid artery occlusion, contralateral laryngeal nerve palsy, previous radical neck surgery or radiation therapy to the neck, recurrent stenosis after endarterectomy, and age of 80 of vulnerable plaques using optical coherence tomography, and confirmed that the CASPER stent significantly reduced the incidence and volume of PP, suggesting it to prevent embolic complications of vulnerable plaques. 22) The CASPER stent, GORE Carotid Stent, and CGuard have achieved favorable early treatment outcomes in clinical studies performed in Western countries.…”

“…Several cases of plaque regression achieved by medical treatment alone including oral antithrombotic drugs have been reported 12 , 13) ; however, mobile plaques are accompanied by a pathologically degenerated arteriosclerotic flap, and ruptured plaques are accompanied by a mobile thrombus, intimal dissection, thin or defective fibrous capsule, lipid-rich necrotic core, and hemorrhage, and have been treated by CEA in many cases. 2 – 5 , 14 , 15) …”

“…1) They are considered a risk factor for ischemic stroke recurrence, but no treatment strategy has been established. 1) A few cases treated by carotid endarterectomy (CEA) [2][3][4][5] or carotid artery stenting (CAS) using an existing stent 6,7) have been reported, but mobile plaques are pathologically fragile and embolic complication caused by plaque protrusion (PP) is problematic; therefore, CAS is considered as a high-risk treatment. 8) On the other hand, new stents such as CASPER stent (MicroVention, Terumo, Tustin, CA, USA), a double-layer micromesh stent (Fig.…”