Author response: Swallowing-induced displacement of the carotid artery as a risk of stroke: Flip-flop phenomenon.

Abstract

We thank Drs. Zaed and Lanzino for the comment on our case report.1 In their previous case report,2 multiple recurrent ischemic events consistently occurred with eating, suggesting a relationship between swallowing and liberation of plaque materials from the internal carotid artery (ICA). As carotid plaques are common in patients with atherosclerosis, it may be difficult to conclude that the retropharyngeal proximal carotid artery is the cause of ischemic stroke. However, further risk assessment may include real-time observation of the postural relationship with hyoid bone or surrounding structures during swallowing, and evaluation of the flip-flop phenomenon (FFP) using carotid ultrasound or dynamic MRI.