ABSTRACT
Transient ischemic attacks (TIAs) can ensue when embolic material forms in the stump and embolizes up the ECA and into the cerebral circulation by trans-ophthalmic collateral pathways. An operation for recurrent stenosis is significantly more difficult than a primary endarterectomy because of the inevitable scarring in the carotid sheath, which distorts the normal anatomy and obscures the usual tissue planes of dissection. Randomized clinical trials such as NASCET have concluded that patients with mild carotid artery stenosis do not benefit from CEA. However, the frequency of patients with fragile plaque including a necrotic core or intra-plaque hemorrhage has been increasing rapidly in recent years. Plaque MRI demonstrated high signal intensity on both T1-weighted images and time-of-flight raw images, strongly suggesting a fragile, unstable plaque with intra-plaque hemorrhage.
