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Interv Neuroradiol. 2016 Aug;22(4):432-7. doi: 10.1177/1591019916633245. Epub 2016 Feb 27.

Neurointerventional management of carotid webs associated with recurrent and acute cerebral ischemic syndromes.

Author information

1
Department of Radiology, Mansoura University, Egypt Department of Radiology, Northwestern University Feinberg School of Medicine, USA mokadem83@yahoo.com.
2
Department of Radiology, Northwestern University Feinberg School of Medicine, USA Department of Neurology, Northwestern University Feinberg School of Medicine, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA.
3
Department of Neurology, Northwestern University Feinberg School of Medicine, USA.
4
Department of Radiology, Northwestern University Feinberg School of Medicine, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA.

Abstract

BACKGROUND:

A carotid web can be defined as an endoluminal shelf-like projection often noted at the origin of the internal carotid artery (ICA) just beyond the bifurcation. Diagnosis of a carotid web as an underlying cause of recurrent ischemic stroke is infrequent and easily misdiagnosed as an atheromatous plaque. Surgery has traditionally been used to resect symptomatic lesions while there is no enough evidence supporting medical therapy as the sole management. To our knowledge there is only one report about carotid artery stenting (CAS) as a definite management of carotid web and no previous reports of acute large-vessel occlusions undergoing mechanical thrombectomy in the setting of carotid web as the etiology.

CASE REPORT:

We report two cases: The first presented with recurrent ischemic stroke in the same arterial territory and the other with an emergent left middle cerebral artery (MCA) occlusion that underwent endovascular mechanical thrombectomy in which initial computed tomographic angiograms (CTA) suggested carotid web etiologies. Following confirmation with digital subtraction angiography (DSA), both patients ultimately underwent endovascular carotid stenting instead of surgical resection for definitive carotid web treatment.

CONCLUSIONS:

Carotid webs are a rare cause of ischemic stroke in young and middle-aged adults that can readily be identified by CTA. Endovascular management may include emergent mechanical thrombectomy for large-vessel thromboembolic complications, and for definitive treatment with carotid stenting across the carotid web as an alternative to surgical resection and medical management for secondary stroke prevention.

KEYWORDS:

Carotid; recurrent; stent; stroke; web

PMID:
26922976
PMCID:
PMC4984381
DOI:
10.1177/1591019916633245
[Indexed for MEDLINE]
Free PMC Article

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