Carotid Artery Stenosis in a Young Asymptomatic Patient: The Value of Multimodal Cross-sectional Imaging

A 56-year-old right-handed patient presented with asymptomatic >70% left internal carotid artery (ICA) stenosis on ultrasound. The peak systolic and end diastolic velocities were 237 and 51 cm/s for an ICA/common carotid artery ratio of 2.8. CT angiography demonstrated 70% ICA stenosis with dissection/ulcerated plaque. Magnetic resonance angiography with vessel wall imaging demonstrated 70% stenosis with enhancing hemorrhagic ulcerated plaque. The patient underwent endarterectomy. Pathology demonstrated calcifications with cholesterol crystals and hemosiderin-laden macrophages (figure).