Sonographic appearance of a free-floating atheromatous plaque in a patient with acute stroke.

We report the case of a neurologically unstable acute stroke patient in whom carotid sonography identified the need for emergency carotid surgery because of an increased risk of distal embolization from a free-floating atheromatous plaque. Longitudinal and transverse sonograms revealed a 6-mm free-floating thrombus loosely attached to the wall of the left common carotid artery. During emergency surgery, a free-floating atheromatous plaque was seen at this location, along with extensive atheromatous lesions. The diseased segment of the common carotid artery was resected and repaired with an interposition graft, and the patient recovered uneventfully, with no recurrence of stroke. Copyright 2002 Wiley Periodicals, Inc.