CEUS Reveals Vulnerable Carotid Plaque Rupture Leading to Stroke: A Case Report

In this case, the patient was admitted to the hospital initially due to neurological symptoms. During a routine ultrasound examination, we observed a plaque with slightly low echogenicity and luminal stenosis at the origin of the right carotid artery. Additionally, we noticed a suspicious area of low echogenicity at the distal end of the plaque that showed slight oscillation with arterial pulsation. CDFI showed a suspicious filling defect. Therefore, we highly suspected acute thrombus formation and performed CEUS after obtaining the patient's informed consent. CEUS confirmed the unenhanced floating thrombus at the distal end of the plaque and also revealed small ulcers and abundant neovascularization within the plaque that were not visible on routine ultrasound. This case of CEUS demonstrated the entire process of vulnerable carotid plaque rupture leading to stroke.