Carotid thin fluttering bands: A new element of arterial wall remodelling? An ultrasound study
Carotid artery ultrasound is a non-invasive and reproducible technique used for early atherosclerotic assessment. Intimal flap has been described in the presence of dissection or mobile plaque rupture, however presence of carotid thin fluttering bands (TFBs) have not been described yet. To investigate frequency, characteristics and impact of TFBs in carotid lumen of patients who underwent carotid ultrasound scan (CUS). 3341 patients were admitted from January 2009 to January 2014. Patients with history of cerebral ischemia (CI) were excluded. In the cases in which TFBs were observed, a 3-months clinical and CUS follow-up (FU) was performed. TFBs were found in 71 patients (2.1 %). The mean age was 63.41 ± 11.20 years (range 42–89). All patients showed a mean increase in intima-media thickness. We identified two subgroups: in 22 patients the TFB was related to a carotid plaque while in 49 no carotid plaque was found. TFB mostly originated in the carotid bulb (88.7 %) and was similarly located in carotid arteries (49.3 % left-side and 50.7 % right-side). CUS and clinical FU were available for all patients (mean duration 25.34 months, median 19). CI occurred in none of the patients. TFB disappeared in 13 patients (18.3 %) with no sign or symptoms of CI. In 3 of 49 patients without carotid plaque (6.1 %), progressive thickening beneath TFB was observed. TFB is a rare finding. Longer FU is needed to evaluate its prognosis. To date, the pathophysiology is unknown, however it could be related to vascular remodeling.
KeywordsCarotid Ultrasound Atherosclerosis Remodelling Thin fluttering band
The authors express their gratitude to Angelo Cauchi and Daniela Manichino for their assistance in revision of the English text.
No extramural funding was used to support this work.
Compliance with ethical standards
Conflict of interest
None of the authors have conflict of interest to disclosure.
A thin fluttering band is visualized in the anterior carotid wall (arrow) in both short and long axis views (B-mode). Color-mode in both short and long sections is also displayed (MP4 15795 kb)
The first part of the video shows the thin fluttering band (arrow) is shown in proximity of a plaque in the right posterior carotid bulb (B-mode scan, long axis view). In the second part, the thin fluttering band (arrow) is located at the origin of the posterior wall of carotid bulb (B-mode scan, long axis view) (MP4 6480 kb)
A thin fluttering band is visualized in both anterior (arrow) and posterior wall of the carotid artery (arrow) (B-mode scan, long axis view) (MP4 4730 kb)
The first part of the video shows thin fluttering band (arrow) at the origin of the posterior wall of the right internal carotid (B-mode scan, long axis view). In the second part the thin fluttering band (arrow) is visualized in the common posterior wall of the right carotid artery (B-mode scan, long axis view) (MP4 7665 kb)
Serial ultrasound scans of thin fluttering band (arrow) in the posterior carotid bulb evaluated with different equipment in both short and long axis B-mode scans (July 2012, equipment: GE Vivid E. July 2013, equipment: Esaote My Lab Twice. January 2015, equipment: GE Logiq S7 Pro) (MP4 18076 kb)
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