The authors report 2 patients who died of massive cerebral infarction secondary to plaque fissuring of and hemorrhage into their carotid atheromas, resulting in overlying thrombosis and total occlusion of the internal carotid arteries. In both cases, the atheromas caused more than 75% reduction in luminal size of the carotid artery. In addition, they were rich in lipid content, which accounted for more than 40% of the cross-sectional area of the atheromatous plaques. It is postulated that high-grade stenotic carotid atheromatous plaques with a high lipid content are at an increased risk of giving rise to subsequent neurologic complications, including massive cerebral infarction, as exemplified by the present 2 reported cases.
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