• Susumu Yamaguchi, Junpei Hamabe, Aya Yamashita, Junji Irie, Nobuhiro Yagi, and Kazuhiko Suyama.
• Department of Neurosurgery, Nagasaki Harbor Medical Center, Nagasaki, Japan. Electronic address: ssmymgc@gmail.com.
• World Neurosurg. 2019 Feb 1; 122: 98-101.

BackgroundA mobile carotid plaque can be detected by duplex ultrasonography and is a high-risk factor for embolic stroke.Case DescriptionWe herein present a case involving an 80-year-old man with an asymptomatic carotid floating flap diagnosed by duplex ultrasonography and treated with carotid endarterectomy. Intraoperatively, an ulceration was found immediately proximal to the neck of the floating flap, and the shape and size of the ulceration were quite similar to those of the floating flap. In a histopathologic examination of the specimen resected by carotid endarterectomy, the plaque lacked the internal elastic lamina (IEL) at the ulceration, calcification was observed in the plaque and medial layer at the ulceration, and the floating flap consisted of the IEL accompanied by calcification, fibrin, and foamy cells.ConclusionsProgression of the atheroma and Mönckeberg sclerosis might have affected disruption of the IEL, causing the IEL to finally peel off. A floating intimal flap accompanied by an atheroma without intraplaque hemorrhage is a rare cause of mobile plaque formation. This type of mobile plaque might not be dissolved by medical treatment alone. In such cases, surgical treatment is a suitable therapeutic choice to prevent stroke.Copyright © 2018 Elsevier Inc. All rights reserved.

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