Carotid Webs in Pediatric Acute Ischemic Stroke

Hassani, Sara; Nogueira, Raul G; Kala, Selina; Philbrook, Bryan; Haussen, Diogo C

doi:10.1016/j.jstrokecerebrovasdis.2020.105333

Cited by 5 publications

(8 citation statements)

References 45 publications

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“…Alternatively, CW may be a remnant of aberrant embryologic development of the carotid bifurcation and internal carotid artery from the third aortic arch . Acquired etiologic theories for CW have also been proposed . Our observation that patients with CW were more often women is consistent with previous CW studies and in line with the predominance of women in FMD .…”

Section: Discussionmentioning

confidence: 99%

Assessment of Recurrent Stroke Risk in Patients With a Carotid Web

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Assessment of Recurrent Stroke Risk in Patients With a Carotid Web

et al. 2021

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“…A carotid web is an intimal variant of fibromuscular dysplasia and rare cause of ischemic stroke 1 . Blood stasis in the web's cul‐de‐sac may result in thrombus formation leading to embolic ischemic strokes.…”

Section: Figurementioning

confidence: 99%

“…The mechanism underlying the formation of carotid web remains unclear. Histology studies have reported the tissue composition of the web to be mostly smooth cell hyperplasia in the intima with or without dissections, myxoid degeneration, and elastic tissue hyperplasia in the web pocket 1,3 . On vessel wall magnetic resonance imaging (VW‐MRI), presence of the peripheral rim of enhancement along the septum may be a result of myxoid degeneration and inflammation within the vessel wall 4 .…”

Section: Figurementioning

confidence: 99%

“…degeneration, and elastic tissue hyperplasia in the web pocket. 1,3 On vessel wall magnetic resonance imaging (VW-MRI), presence of the peripheral rim of enhancement along the septum may be a result of myxoid degeneration and inflammation within the vessel wall. 4 Use of VW-MRI may provide more precise characterization of carotid pathology to guide treatment.…”

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Vessel Wall Imaging of a Carotid Web

Stein

Cucchiara

et al. 2022

Annals of Neurology

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A carotid web is an intimal variant of fibromuscular dysplasia and rare cause of ischemic stroke. 1 Blood stasis in the web's cul-de-sac may result in thrombus formation leading to embolic ischemic strokes. A study found recurrent strokes to occur in approximately 17% of patients with carotid webs during 2 year follow-up. 2 The mechanism underlying the formation of carotid web remains unclear. Histology studies have reported the tissue composition of the web to be mostly smooth cell hyperplasia in the intima with or without dissections, myxoid FIGURE: A 61-year-old man with a history of hypertension and hyperlipidemia presented with left lower facial weakness and transient slurred speech. Initial examination was notable for mild left facial droop. Brain magnetic resonance imaging (MRI) revealed a right insular cortex acute infarct (Fig ). Computed tomography angiography (CTA) of the head and neck showed a right M2 middle cerebral artery (MCA) occlusion and a thin linear incomplete membranous intraluminal filling defect with a shelflike appearance along the posterior wall of the right carotid artery bifurcation (Fig , arrowhead). Imaging findings were suggestive of a carotid web with an ulcerated plaque as a consideration. A vessel wall (VW) MRI 2 weeks after initial presentation again demonstrated a shelf-like protrusion along the posterior wall of the right carotid bifurcation. Precontrast sagittal-oblique VW-MRI showed eccentric wall thickening (Fig , arrowhead) with a thin membranous septum best appreciated on axial views (Fig , inset). There was no intrinsic T1 hyperintense signal associated with the vessel wall abnormality (Fig ). On postcontrast sagittal VW-MRI (Fig ), the membrane showed peripheral enhancement (Fig , arrowhead and inset) with relative central hypo-enhancement. Absence of intrinsic T1 hyperintense signal on precontrast imaging suggested no vulnerable plaque components, such as intraplaque hemorrhage, and no intramural hematoma to suggest an arterial dissection. There was no surface irregularity with patchy postcontrast enhancement to suggest an ulcerated plaque. The CTA appearance and enhancing septum with relative central hypo-enhancement inferiorly on VW-MRI was most consistent with a carotid web with thromboembolism distally leading to the right M2 occlusion.

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