Carotid web: the challenging diagnosis of an under-recognized entity.
Carotid revascularization
Carotid web
Histology
Ischemic stroke
Prevention
Transient ischemic attack
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Oct 2022
Oct 2022
Historique:
received:
19
04
2022
accepted:
30
05
2022
revised:
27
05
2022
pubmed:
18
6
2022
medline:
15
9
2022
entrez:
17
6
2022
Statut:
ppublish
Résumé
Determining the cause of acute ischemic stroke is crucial for patient management, particularly for preventing future stroke. In recent years, carotid web (CW), a non-atherosclerotic disorder of the carotid wall, has been found to be an underestimated source of cerebral emboli. The present study aimed to analyze the clinical, radiological, and pathological findings, along with the treatments performed in patients with CW and ipsilateral ischemic events. Patients with anterior circulation ischemic stroke or transient ischemic attack and ipsilateral CW were prospectively included from January 2019 to December 2021. Nine patients were enrolled. The median age was 55 (43-62) years, with a female-to-male ratio of 3.5:1. Of the total, seven patients (78%) consulted for recurrent ipsilateral ischemic events. Despite medical treatment, 44% of the patients experienced new episodes. Computed tomographic angiography was suggestive of CW in all cases in which it was performed. The interval between the first ischemic event and diagnosis of CW was of 13 (6-68) months. After ruling out any other possible etiology, every patient underwent carotid revascularization, one underwent stenting and eight underwent carotidectomy. No severe or long-term complications were noted. Histological studies confirmed the diagnosis of CW. There were no recurrences after carotid revascularization during a follow-up of 24 (13-35) months. Knowledge of CW and differentiating it from atheroma plaques is essential, as medical management seems to be insufficient in many cases. Revascularization, which has been shown to be safe and effective, might be the best treatment modality.
Sections du résumé
BACKGROUND
BACKGROUND
Determining the cause of acute ischemic stroke is crucial for patient management, particularly for preventing future stroke. In recent years, carotid web (CW), a non-atherosclerotic disorder of the carotid wall, has been found to be an underestimated source of cerebral emboli.
OBJECTIVE
OBJECTIVE
The present study aimed to analyze the clinical, radiological, and pathological findings, along with the treatments performed in patients with CW and ipsilateral ischemic events.
METHODS
METHODS
Patients with anterior circulation ischemic stroke or transient ischemic attack and ipsilateral CW were prospectively included from January 2019 to December 2021.
RESULTS
RESULTS
Nine patients were enrolled. The median age was 55 (43-62) years, with a female-to-male ratio of 3.5:1. Of the total, seven patients (78%) consulted for recurrent ipsilateral ischemic events. Despite medical treatment, 44% of the patients experienced new episodes. Computed tomographic angiography was suggestive of CW in all cases in which it was performed. The interval between the first ischemic event and diagnosis of CW was of 13 (6-68) months. After ruling out any other possible etiology, every patient underwent carotid revascularization, one underwent stenting and eight underwent carotidectomy. No severe or long-term complications were noted. Histological studies confirmed the diagnosis of CW. There were no recurrences after carotid revascularization during a follow-up of 24 (13-35) months.
CONCLUSION
CONCLUSIONS
Knowledge of CW and differentiating it from atheroma plaques is essential, as medical management seems to be insufficient in many cases. Revascularization, which has been shown to be safe and effective, might be the best treatment modality.
Identifiants
pubmed: 35713691
doi: 10.1007/s00415-022-11210-y
pii: 10.1007/s00415-022-11210-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5629-5637Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
Hart RG, Diener HC, Coutts SB et al (2014) Embolic strokes of undetermined source: The case for a new clinical construct. Lancet Neurol 13:429–438. https://doi.org/10.1016/s1474-4422(13)70310-7
doi: 10.1016/s1474-4422(13)70310-7
pubmed: 24646875
Hart RG, Catanese L, Perera KS et al (2017) Embolic stroke of undetermined source: a systematic review and clinical update. Stroke 48:867–872. https://doi.org/10.1161/STROKEAHA.116.016414
doi: 10.1161/STROKEAHA.116.016414
pubmed: 28265016
Ospel JM, Singh N, Marko M et al (2020) Prevalence of ipsilateral nonstenotic carotid plaques on computed tomography angiography in embolic stroke of undetermined source. Stroke 51:1743–1749. https://doi.org/10.1161/STROKEAHA.120.029404
doi: 10.1161/STROKEAHA.120.029404
pubmed: 32375585
Kamtchum-Tatuene J, Wilman A, Saqqur M et al (2020) Carotid plaque with high-risk features in embolic stroke of undetermined source: systematic review and meta-analysis. Stroke 51:311–314. https://doi.org/10.1161/STROKEAHA.119.027272
doi: 10.1161/STROKEAHA.119.027272
pubmed: 31752616
Coutinho JM, Derkatch S, Potvin ARJ et al (2016) Nonstenotic carotid plaque on CT angiography in patients with cryptogenic stroke. Neurology 87:665–672. https://doi.org/10.1212/WNL.0000000000002978
doi: 10.1212/WNL.0000000000002978
pubmed: 27412144
pmcid: 4999163
Goyal M, Singh N, Marko M et al (2020) Embolic stroke of undetermined source and symptomatic nonstenotic carotid disease. Stroke 51:1321–1325. https://doi.org/10.1161/STROKEAHA.119.028853
doi: 10.1161/STROKEAHA.119.028853
pubmed: 32138632
Coutinho JM, Derkatch S, Potvin ARJ et al (2017) Carotid artery web and ischemic stroke: A case-control study. Neurology 88:65–69. https://doi.org/10.1212/WNL.0000000000003464
doi: 10.1212/WNL.0000000000003464
pubmed: 27864523
pmcid: 5200857
Rainer WG, Cramer GG, Newby JP et al (1968) Fibromuscular hyperplasia of the carotid artery causing positional cerebral ischemia. Ann Surg 167:444–446. https://doi.org/10.1097/00000658-196803000-00021
doi: 10.1097/00000658-196803000-00021
pubmed: 5638530
pmcid: 1387077
Kim SJ, Nogueira RG, Haussen DC (2019) Current understanding and gaps in research of carotid webs in ischemic strokes: a review. JAMA Neurol 76:355–361. https://doi.org/10.1001/jamaneurol.2018.3366
doi: 10.1001/jamaneurol.2018.3366
pubmed: 30398546
Touzé E, Southerland AM, Boulanger M et al (2019) Fibromuscular dysplasia and its neurologic manifestations: a systematic review. JAMA Neurol 76:217–226. https://doi.org/10.1001/jamaneurol.2018.2848
doi: 10.1001/jamaneurol.2018.2848
pubmed: 30285053
Joux J, Boulanger M, Jeannin S et al (2016) Association between carotid bulb diaphragm and ischemic stroke in young Afro-Caribbean patients: a population-based case-control study. Stroke 47:2641–2644. https://doi.org/10.1161/STROKEAHA.116.013918
doi: 10.1161/STROKEAHA.116.013918
pubmed: 27625379
Sajedi PI, Gonzalez JN, Cronin CA et al (2017) Carotid bulb webs as a cause of “cryptogenic” ischemic stroke. AJNR Am J Neuroradiol 38:1399–1404. https://doi.org/10.3174/ajnr.A5208
doi: 10.3174/ajnr.A5208
pubmed: 28495950
pmcid: 7959897
Kim SJ, Allen JW, Bouslama M et al (2019) Carotid webs in cryptogenic ischemic strokes: a matched case-control study. J Stroke Cerebrovasc Dis 28:104402. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104402
doi: 10.1016/j.jstrokecerebrovasdis.2019.104402
pubmed: 31563567
Park CC, el Sayed R, Risk BB, et al (2021) Carotid webs produce greater hemodynamic disturbances than atherosclerotic disease: a DSA time-density curve study. J Neurointerv Surg Published Online First: 27 July 2021. https://doi.org/10.1136/NEURINTSURG-2021-017588
Zhang AJ, Dhruv P, Choi P et al (2018) A systematic literature review of patients with Carotid web and acute ischemic stroke. Stroke 49:2872–2876. https://doi.org/10.1161/STROKEAHA.118.021907
doi: 10.1161/STROKEAHA.118.021907
pubmed: 30571430
Choi PMC, Singh D, Trivedi A et al (2015) Carotid webs and recurrent ischemic strokes in the Era of CT angiography. AJNR Am J Neuroradiol 36:2134–2139. https://doi.org/10.3174/ajnr.A4431
doi: 10.3174/ajnr.A4431
pubmed: 26228877
pmcid: 7964886
Compagne KCJ, Van Es ACGM, Berkhemer OA et al (2018) Prevalence of carotid web in patients with acute intracranial stroke due to intracranial large vessel occlusion. Radiology 286:1000–1007. https://doi.org/10.1148/radiol.2017170094
doi: 10.1148/radiol.2017170094
pubmed: 29040040
Schoephoerster RT, Oynes F, Nunez G et al (1993) Effects of local geometry and fluid dynamics on regional platelet deposition on artificial surfaces. Arterioscler Thromb 13:1806–1813. https://doi.org/10.1161/01.atv.13.12.1806
doi: 10.1161/01.atv.13.12.1806
pubmed: 8241101
Chatzizisis YS, Coskun AU, Jonas M et al (2007) Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. J Am Coll Cardiol 49:2379–2393. https://doi.org/10.1016/j.jacc.2007.02.059
doi: 10.1016/j.jacc.2007.02.059
pubmed: 17599600
Madaelil TP, Grossberg JA, Nogueira RG et al (2019) Multimodality imaging in carotid web. Front Neurol 10:220. https://doi.org/10.3389/fneur.2019.00220
doi: 10.3389/fneur.2019.00220
pubmed: 30915028
pmcid: 6423072
Mac Grory B, Emmer BJ, Roosendaal SD et al (2020) Carotid web: an occult mechanism of embolic stroke. J Neurol Neurosurg Psychiatry 91:1283–1289. https://doi.org/10.1136/jnnp-2020-323938
doi: 10.1136/jnnp-2020-323938
pubmed: 33004431
Joux J, Chausson N, Jeannin S et al (2014) Carotid-bulb atypical fibromuscular dysplasia in young Afro-Caribbean patients with stroke. Stroke 45:3711–3713. https://doi.org/10.1161/STROKEAHA.114.007313
doi: 10.1161/STROKEAHA.114.007313
pubmed: 25358695
Sajedi P, Chelala L, Nunez-Gonalez J et al (2019) Carotid webs and ischemic stroke: Experiences in a comprehensive stroke center. J Neuroradiol 46:136–140. https://doi.org/10.1016/j.neurad.2018.09.003
doi: 10.1016/j.neurad.2018.09.003
pubmed: 30273631
Hu H, Zhang X, Zhao J et al (2019) Transient ischemic attack and carotid web. AJNR Am J Neuroradiol 40:313–318. https://doi.org/10.3174/ajnr.A5946
doi: 10.3174/ajnr.A5946
pubmed: 30655258
pmcid: 7028627
Guglielmi V, Compagne KCJ, Sarrami AH et al (2021) Assessment of recurrent stroke risk in patients with a carotid web. JAMA Neurol 78:826–833. https://doi.org/10.1001/jamaneurol.2021.1101
doi: 10.1001/jamaneurol.2021.1101
pubmed: 33970205
Haussen DC, Grossberg JA, Koch S et al (2018) Multicenter experience with stenting for symptomatic carotid web. Interv Neurol 7:413–418. https://doi.org/10.1159/000489710
doi: 10.1159/000489710
pubmed: 30410519
pmcid: 6216720
Haussen DC, Grossberg JA, Bouslama M et al (2017) Carotid web (intimal Fibromuscular Dysplasia) has high stroke recurrence risk and is amenable to stenting. Stroke 48:3134–3137. https://doi.org/10.1161/STROKEAHA.117.019020
doi: 10.1161/STROKEAHA.117.019020
pubmed: 29018133
Rodríguez-Castro E, Pumar JM, Arias-Rivas S (2020) Letter by Rodríguez-Castro et al Regarding Article, “Embolic Stroke of Undetermined Source and Symptomatic Nonstenotic Carotid Disease.” Stroke 51:e318–e319. https://doi.org/10.1161/STROKEAHA.120.031114
doi: 10.1161/STROKEAHA.120.031114
pubmed: 33104462