PMC9519131_01
The emergency non-contrast CT (NCCT) (a,b) and cranial CT angiography (CTA) (c) did not show obvious cranial abnormalities; whole-brain CT perfusion (WB-CTP) indicated the left hemisphere core infarction (d,e); The 4D-CTA reconstruction showed delayed imaging of the left middle cerebral artery [(f), yellow arrow].
fcvm-09-961760-g0001.jpg
PMC9519131_01_fcvm-09-961760-g0001.jpg
F1
Technology, Melbourne, Australia). The 4D-CTA reconstruction showed delayed imaging of the left internal carotid system, suggesting severe proximal obstructive disease (Figure 1).
Diffusion-weighted imaging (DWI) showed multiple infarctions in the left hemisphere (a,b); Carotid ultrasound (c,d) indicated a culprit plaque with local floating thrombus (yellow arrow), resulting in obvious stenosis of the left internal carotid artery; carotid CTA (e,f) presented the floating thrombus (red arrow) with a typical cross-sectional "donut sign" (white arrow).
fcvm-09-961760-g0002.jpg
PMC9519131_01_fcvm-09-961760-g0002.jpg
F2
Two days after admission, there was no obvious change in the ultrasound review, and the carotid CTA presented a typical "donut sign," indicating a CFFT rather than only a vulnerable plaque (Figure 2).
Carotid DSA before aspiration (a); The FlowGate2 balloon guide catheter (yellow arrow) is placed in the left common carotid artery and the Emboshield NAV6 embolic protection system (white arrow) is placed in the distal segment of the internal carotid artery (b); The Mach1 guide catheter (red arrow) is inserted to aspirate CFFT (c); Ultrasound probe depressing Mach1 tip (red arrow) to face the thrombus (d); Carotid DSA after aspiration (e); Massive thrombus has been aspirated (f); Postoperative contrast-enhanced ultrasound showed unstable plaque with no evidence of CFFT (g).
fcvm-09-961760-g0003.jpg
PMC9519131_01_fcvm-09-961760-g0003.jpg
F3
On the next day, contrast-enhanced ultrasound (CEUS) showed only an unstable plaque in the region of CFFT (Figure 3).
Hematoxylin and eosin stain presented a fresh thrombus that was rich in red blood cells and platelets.
fcvm-09-961760-g0004.jpg
PMC9519131_01_fcvm-09-961760-g0004.jpg
F4
Pathological examination revealed fresh thrombi, rich in red blood cells and platelets (Figure 4).