PMC8740315_01
(A,B) High-resolution T1 and T2 weighted images of plaque. The ratio of the highest signal intensity of carotid plaque to sternocleidomastoid muscle was more than 2.0. (C) Digital subtraction angiography confirms an irregular filling defect. Asterisk indicates the plaque component. SCM, sternocleidomastoid muscle.
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F1
Subsequent digital subtraction angiography (DSA) confirmed left intracranial vertebral artery stenosis of 75% and right common carotid artery (CCA) stenosis of 80% with a luminal irregular filling defect (Figure 1).
(A) C-arm cone-beam CT (CBCT) shows enhancement on the surface of the carotid plaque in cross-section imaging. The white arrow points to microcalcification, white broken arrow points to neovascularization. (B) Hematoxylin & eosin stain demonstrates the corresponding area on CBCT (5x). (B1) Higher power magnification shows microcalcification (asterisk) (50x). (B2,B3) Higher power magnification corresponding to the area outlined by the black box in (B); broken arrow points to neovascularization (50x). (C) CBCT shows contrast enhancement from the artery lumen toward the inside of the plaque as the line shape (broken arrow). (D) H&E confirms fibrous rupture (5x). (E) Higher-power magnification corresponding to the area outlined by the black box in (D); arrow points at fibrous cap rupture, and beside the rupture exists a large pool of erythrocytes (50x).
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F2
Histopathology confirmed that the high-density areas represented neovascularization and macrocalcification, with linear enhancement representing plaque rupture (Figure 2).