Atherosclerotic narrowing at the bifurcation of the common carotid artery is by far the most common cause of large-vessel atherothrombotic stroke. Atherosclerotic plaque tends to form in the posterior part of the bifurcation, at the origin of the internal carotid artery, narrowing the lumen until it resembles an hourglass whose tapered segment is usually 1 to 2 mm long. A mural thrombus may form at, or near, the residual lumen,1,2 which is usually located eccentrically in the anterior medial portion of the proximal internal carotid artery. Occasionally, blood from the lumen penetrates into the plaque. This penetration may be the.
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