Serial carotid MRI identifies rupture of a vulnerable plaque resulting in amaurosis fugax.

A 66-year-old man with cryptogenic ischemic stroke and multiple acute ischemic lesions in the right middle cerebral artery territory was enrolled in the CAPIAS trial (Carotid Plaque Imaging in Acute Stroke; NCT01284933). Baseline carotid MRI demonstrated a right-sided nonstenotic American Heart Association type-VI plaque with a large lipid/necrotic core and intraplaque hemorrhage (figure 1). Eleven months later, the patient presented again after an episode of right eye amaurosis fugax. Repeat carotid MRI revealed a new ulceration on the right side with large parts of the former lipid/necrotic core missing (figure 2). We hypothesize that plaque rupture had caused embolization into the right retinal artery. Figure 1 Baseline high-resolution carotid MRI after cryptogenic stroke