SHM Converge Scientific Abstract ePoster Gallery-Coughing Spells and the Carotids: Exploring the Role of Respiratory Mechanics in Carotid Plaque Rupture

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This document describes a rare suspected case of cough-induced carotid plaque rupture leading to ischemic stroke. Carotid artery stenosis, usually due to atherosclerosis, is a known risk factor for stroke and TIA. Although coughing has previously been linked to carotid artery dissection, the report notes no prior cases of cough-triggered carotid plaque rupture.<br /><br />The patient was an 82-year-old man with hypertension, COPD, prior ischemic stroke, mild carotid stenosis, and hyperlipidemia. After a witnessed coughing spell, he developed expressive aphasia, dysarthria, confusion, and left-sided weakness. CT angiography showed a ruptured irregular plaque in the proximal right internal carotid artery causing more than 60% stenosis, along with a likely occluded right posterior cerebral artery and evidence of acute infarct with a larger area of penumbra/ischemia. A small saccular aneurysm was also seen near the right internal carotid artery terminus.<br /><br />The case suggests that intense coughing may increase intrathoracic and intravascular pressure enough to mechanically stress vulnerable atherosclerotic plaques, potentially triggering rupture and embolic stroke. Patients with COPD and carotid stenosis may be especially susceptible because of chronic coughing and underlying vascular disease.<br /><br />The report emphasizes closer monitoring and aggressive medical management in such patients, including antiplatelet therapy and statins. It also raises the possibility that endarterectomy thresholds might be reconsidered in patients with chronic cough risk. Finally, it underscores the importance of patient education and seeking immediate care for stroke symptoms.

Asset Subtitle

Camila A. Ramirez Ramos

Meta Tag

Author List Anas Bizanti, Camila A. Ramirez Ramos, Daniela Carralero-Somoza, Michael Sabina, Zein Barakat

Category Clinical Vignettes

Concept Carotid Artery Disease

Concept Ischemic Stroke

Concept Carotid Plaque Rupture

Concept Acute Ischemic Stroke

Concept Atherosclerotic Disease

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Camila A. Ramirez Ramos

Track Adult

Keywords

cough-induced carotid plaque rupture

ischemic stroke

carotid artery stenosis

atherosclerosis

internal carotid artery

coughing spell

embolic stroke

COPD

antiplatelet therapy

statins

Carotid Artery Disease

Ischemic Stroke

Carotid Plaque Rupture

Acute Ischemic Stroke

Atherosclerotic Disease