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Olindo S, Marnat G, Chausson N, Turpinat C, Smadja D, Gaillard N. Carotid webs associated with ischemic stroke. Updated general review and research directions. Rev Neurol (Paris) 2021; 177:627-638. [PMID: 33455831 DOI: 10.1016/j.neurol.2020.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/02/2020] [Indexed: 11/26/2022]
Abstract
Carotid web (CaW) is an intimal variant of fibromuscular dysplasia strongly associated with ipsilateral cerebral infarction. Although considered rare, it is a recent and increasing concern for physicians involved in stroke diagnosis and management. The present general review relies on a systematic literature analysis and aims to update readers on the latest knowledge in the field of symptomatic CaW (syCaW). CaW associated with ipsilateral cerebral infarction or transient ischemic attack has been identified in 189 patients. Ischemic strokes (IS) mostly occur in middle age (mean 46 years) and predominately in females (66%). The high frequency of African descendant patients among case reports and series (58%) suggests an ethnic susceptibility for CaW development. CaW features are characterised by a shelf-like intraluminal defect on contrast sagittal imaging, a linear defect that splits the lumen on axial section, a post-contrast stagnation rostral to the lesion and a frequent contralateral mirrored CaW (26.6%). An artery-to-artery embolism mechanism is widely accepted via CaW blood stasis, thrombus formation and clot fragmentation scattered by blood flow. Therefore, cerebral infarctions are often large related to a high proportion of proximal occlusion (62.5%). CaW confers a high rate of IS recurrence despite standard anti-platelet treatment that reaches 33.3% of patients prospectively followed with a median time to event of one year. Although no randomised therapeutic studies are available, surgery (n=39) or stenting (n=50) have been often proposed and seem to avoid recurrences. CaW clearly emerges as a cause of cryptogenic embolic stroke and should be systematically investigated in routine. A large number of points remain to be elucidated and CaW patients should be steadily included in registries and randomised therapeutic studies.
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Affiliation(s)
- S Olindo
- Department of neurology, Stroke centre, University hospital of Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
| | - G Marnat
- Department of diagnostic and interventional neuroradiology, University hospital of Bordeaux, Bordeaux, France
| | - N Chausson
- Department of neurology, Stroke centre, Hospital Sud Francilien, Corbeil-Essonnes, France
| | - C Turpinat
- Department of neurology, Stroke centre, University hospital of Montpellier, Montpellier, France
| | - D Smadja
- Department of neurology, Stroke centre, Hospital Sud Francilien, Corbeil-Essonnes, France
| | - N Gaillard
- Department of neurology, Stroke centre, University hospital of Montpellier, Montpellier, France
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Ning B, Zhang D, Sui B, He W. Ultrasound imaging of carotid web with atherosclerosis plaque: a case report. J Med Case Rep 2020; 14:145. [PMID: 32895054 PMCID: PMC7487535 DOI: 10.1186/s13256-020-02446-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 06/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To the best of our knowledge, no previous studies on carotid webs with atherosclerosis plaque have been conducted. Thus, both radiologists and clinicians have insufficient knowledge of this disease, which could lead to misdiagnosis and missed diagnosis. An accurate diagnosis is beneficial to clinical management and prevention of stroke. Here, we present a case of a carotid web with an atherosclerotic plaque, which was confirmed by histopathology and was treated at the Department of Neurosurgery, Beijing Tiantan Hospital. CASE PRESENTATION We report a rare case of a carotid web with an atherosclerotic plaque in a 61-year-old Han man. He presented to our hospital with history of intermittent dizziness and slurred speech for 1.5 years and numbness of both upper limbs for 4 months. A computed tomography angiography examination indicated severe stenosis at the beginning of the left internal carotid artery with plaque surface ulceration. Doppler ultrasound examination showed a carotid web with a thin isoechoic plaque and a membrane-like structure protruding into the lumen from the lateral posterior wall at the beginning of the left internal carotid artery. The thin isoechoic plaque could be seen at the base of the membrane-like structure. Carotid endarterectomy was performed to alleviate symptoms. A carotid web with atherosclerosis was diagnosed intraoperatively, and postoperative pathology confirmed extensive intima fibroid hyperplasia accompanied with myxoid degeneration. The base of the carotid web was attached to the thin atherosclerosis plaque, and between the web and the plaque, a cavity was observed. In this case report, we aim to discuss the diagnosis of carotid web with atherosclerosis, its physiopathology and management, and the possible reasons for missed diagnosis or misdiagnosis. CONCLUSION Carotid webs with atherosclerosis have no known etiological factors and are rarely reported. Thus, carotid webs could be easily confused with ulcerations on the surface of the atherosclerosis plaque. The diagnosis could be difficult and effective management remains indeterminate. Moreover, prompt recognition of this disease is key to correct treatment and management. Hence, this case report and the relevant data in the literature could contribute to the improvement of the diagnosis and treatment of this disease.
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Affiliation(s)
- Bin Ning
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No. 119, 4th South Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, 4th South Ring West Road, Fengtai District, Beijing, 100070, China
| | - Binbin Sui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, 4th South Ring West Road, Fengtai District, Beijing, 100070, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No. 119, 4th South Ring West Road, Fengtai District, Beijing, 100070, China
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Bennani H, Alami B, Hajjar C, Quenum L, Haloua M, Boubbou M, Belahcen F, Maâroufi M, Alaoui Lamrani MY. Symptomatic carotid web: About a rare ultrasound finding. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:284-287. [PMID: 32862986 DOI: 10.1016/j.jdmv.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- H Bennani
- Radiology department, CHU Hassan II, 1, rue El Badie, route Immouzer, Fès, Morocco.
| | - B Alami
- Radiology department, CHU Hassan II, 1, rue El Badie, route Immouzer, Fès, Morocco
| | - C Hajjar
- Radiology department, CHU Hassan II, 1, rue El Badie, route Immouzer, Fès, Morocco
| | - L Quenum
- Radiology department, CHU Hassan II, 1, rue El Badie, route Immouzer, Fès, Morocco
| | - M Haloua
- Radiology department, CHU Hassan II, 1, rue El Badie, route Immouzer, Fès, Morocco
| | - M Boubbou
- Radiology department, CHU Hassan II, 1, rue El Badie, route Immouzer, Fès, Morocco
| | - F Belahcen
- Neurology department, CHU Hassan II, Fès, Morocco
| | - M Maâroufi
- Radiology department, CHU Hassan II, 1, rue El Badie, route Immouzer, Fès, Morocco
| | - M Y Alaoui Lamrani
- Radiology department, CHU Hassan II, 1, rue El Badie, route Immouzer, Fès, Morocco
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Choi PMC, Singh D, Trivedi A, Qazi E, George D, Wong J, Demchuk AM, Goyal M, Hill MD, Menon BK. Carotid Webs and Recurrent Ischemic Strokes in the Era of CT Angiography. AJNR Am J Neuroradiol 2015; 36:2134-9. [PMID: 26228877 DOI: 10.3174/ajnr.a4431] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/19/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Carotid webs may cause recurrent ischemic stroke. We describe the prevalence, demographics, clinical presentation, imaging features, histopathology, and stroke risk associated with this under-recognized lesion. MATERIALS AND METHODS A carotid web was defined on CTA as a thin intraluminal filling defect along the posterior wall of the carotid bulb just beyond the carotid bifurcation on oblique sagittal section CTA that was seen as a septum on axial CTA. Using a prospective case series from April 2013 to April 2014, we describe the demographics, spectrum of imaging features on CTA, and histopathology of these carotid webs. From a retrospective analysis of patients at our center from May 2012 to April 2013 who had a baseline head and neck CTA followed by a brain MR imaging within 1-2 days of the CTA, we determine the period prevalence of carotid webs and the prevalence of ipsilateral stroke on imaging. RESULTS In the prospective series, the mean age was 50 years (range, 41-55 years); 5/7 patients were women. Recurrent stroke was seen in 5/7 (71.4%) patients with the carotid web; time to recurrence ranged from 1 to 97 months. Histopathology suggested a high probability of fibromuscular dysplasia. In the retrospective series, carotid webs were seen in 7/576 patients for a hospital-based-period prevalence of 1.2% (95% CI, 0.4%-2.5%). Two of these 7 patients had acute stroke in the vascular territory of the carotid web. CONCLUSIONS A carotid web may contribute to recurrent ischemic stroke in patients with no other determined stroke mechanism. Intimal variant fibromuscular dysplasia is the pathologic diagnosis in most cases. The prevalence of carotid web is low, while the optimal management strategy remains unknown.
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Affiliation(s)
- P M C Choi
- From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.)
| | - D Singh
- From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.)
| | - A Trivedi
- From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.)
| | - E Qazi
- From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.)
| | - D George
- Departments of Pathology and Laboratory Medicine (D.G.)
| | - J Wong
- From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.) Radiology (J.W., A.M.D., M.G., M.D.H., B.K.M.)
| | - A M Demchuk
- From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.) Radiology (J.W., A.M.D., M.G., M.D.H., B.K.M.) Hotchkiss Brain Institute (A.M.D., M.G., M.D.H., B.K.M.), Calgary, Alberta, Canada
| | - M Goyal
- From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.) Radiology (J.W., A.M.D., M.G., M.D.H., B.K.M.) Hotchkiss Brain Institute (A.M.D., M.G., M.D.H., B.K.M.), Calgary, Alberta, Canada
| | - M D Hill
- From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.) Radiology (J.W., A.M.D., M.G., M.D.H., B.K.M.) Medicine and Community Health Science (M.D.H.), University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute (A.M.D., M.G., M.D.H., B.K.M.), Calgary, Alberta, Canada
| | - B K Menon
- From the Calgary Stroke Program, Department of Clinical Neuroscience (P.M.C.C., D.S., A.T., E.Q., J.W., A.M.D., M.G., M.D.H., B.K.M.) Radiology (J.W., A.M.D., M.G., M.D.H., B.K.M.) Hotchkiss Brain Institute (A.M.D., M.G., M.D.H., B.K.M.), Calgary, Alberta, Canada.
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Fu W, Crockett A, Low G, Patel V. Internal Carotid Artery Web: Doppler Ultrasound with CT Angiography correlation. J Radiol Case Rep 2015; 9:1-6. [PMID: 26622927 DOI: 10.3941/jrcr.v9i5.2434] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a case of an internal carotid web, detected on duplex ultrasound and confirmed by CT angiography. To our knowledge, this is only the third reported ultrasound case in the imaging literature. This vascular abnormality can cause a clinically significant carotid stenosis and is a risk factor for recurrent embolic cerebrovascular events. Due to small size and poor awareness among radiologists, carotid webs are often under-diagnosed on non-invasive imaging modalities. Improved awareness including knowledge of salient imaging features is useful as early diagnosis leading to appropriate intervention can eliminate the risk of future cerebrovascular events.
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Affiliation(s)
- Winnie Fu
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Ann Crockett
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Vimal Patel
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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