Unusual Evolution of Carotid Atherosclerosis in a Patient with Transient Ischemic Attack

Here, we report an unusual case of a nonsmoker and hypertensive 72-year-old male who was admitted with a transient ischemic attack to the Neurology Department of Clinical County Emergency Hospital Bihor. He presented a first transient ischemic attack and paroxysmal atrial fibrilation 2 years before, when anticoagulation was started on top of his antihypertensive medication. At that time, carotid Doppler ultrasound revealed nonobstructive atherosclerosis and statin therapy was started, according to current guidelines, in order to lower the initial 70 mg/dL LDL-cholesterol level to under 55 mg/dL. Cardio-embolism was considered the mechanism of stroke at that time. Despite all the medication and the maintenance of LDL below 50 mg/dL, carotid atherosclerosis evolved to an important left internal carotid artery stenosis and transient ischemic attacks reappeared two years later. Carotid stenosis was then considered the most probable cause, although elucidating the exact mechanism was difficult. After medical treatment and subsequent endarterectomy, the patient had a good outcome. The progressive course of atheromatosis, despite maximal medication, urged us to look for further proper measures of prevention. No chronic disease was detected during the postoperative phase, except for early-stage periodontal disease, for which adequate preventive measures were applied. Considering that subclinical inflammation induced by periodontal disease can induce the progression of atherosclerosis, chronic treatment with colchicine was added, with a favorable outcome.