ABSTRACT
These two cases illustrate again the importance of relying on the clinical history and examination in the assessment of symptomatic carotid patients. In the first case, the lateral view (A) demonstrates a double density in the ICA, but no good evidence for significant stenosis is identified. A case such as this might be passed to medical management and regarded as an insignificant carotid artery. The AP view (B) demonstrates evidence of an ulceration in the lateral wall of the carotid bulb. This particular patient had a history of TIAs refractory to medical therapy and was believed to be a surgical candidate. The operative specimen shown below (left) demonstrates a significant soft, friable intraluminal plaque at the carotid bulb with an ulcer as identified on the AP carotid view.
