Current Understanding and Gaps in Research of Carotid Webs in Ischemic Strokes

Kim, Song; Nogueira, Raul G; Haussen, Diogo C

doi:10.1001/jamaneurol.2018.3366

Cited by 108 publications

(159 citation statements)

References 43 publications

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“…carotid web. Hierbei handelt es sich um dünnes membranöses Gewebe, das meist am Abgang der A. carotis interna von der Gefäßwand ins Lumen reicht und über arterioarterielle Embolien ischämische Schlaganfälle verursacht [18]. In der Altersgruppe unter 60 Jahre wurde in Fall-Kontroll-Studien bei 9,4-37 % der Patienten mit kryptogenem Schlaganfall ein ipsilaterales carotid web nachgewiesen [18].…”

Section: Carotid Webunclassified

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Seltene Schlaganfallursachen – im Alltag gar nicht so selten

Schmidt‐Pogoda

Minnerup

2019

Nervenarzt

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Seltene Schlaganfallursachenim Alltag gar nicht so seltenBei mindestens 5 % der Schlaganfallpatienten liegt eine sog. seltene Ursache vor. Bei jungen Patienten ist dieser Anteil noch deutlich höher. Zudem ist anzunehmen, dass sich auch unter den ungeklärten Schlaganfallätiologien solche mit seltener Ursache verbergen. Deren Kenntnis kommt somit eine große Bedeutung zu. Im Folgenden geben wir einen Überblick über seltene Schlaganfallursachen, die in unserem Alltag auf der Stroke Unit gar nicht so selten sind.

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Section: Carotid Webunclassified

“…Als Therapiealternativen werden die offene Operation, endovaskuläres Stenting sowie eine duale Thrombozytenaggregationshemmung eingesetzt. Eine kleine prospektive Studie hat einen Vorteil des Stentings gegenüber der Thrombozytenaggregationshemmung gezeigt, insgesamt ist die Datenlage zur optimalen Therapie jedoch limitiert [18].…”

Section: Carotid Webunclassified

Seltene Schlaganfallursachen – im Alltag gar nicht so selten

Schmidt‐Pogoda

Minnerup

2019

Nervenarzt

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“…Carotid web is a shelf-like projection in the lumen of the internal carotid artery bulb and is recognized as a cause of stroke. However, the optimal treatment for symptomatic carotid web has not been thoroughly investigated (1). Moreover, congenital protein C deficiency induces thrombogenicity and also increases the risk of arterial thromboembolism, especially in young patients.…”

Section: Introductionmentioning

confidence: 99%

A Case of Ischemic Stroke With Congenital Protein C Deficiency and Carotid Web Successfully Treated by Anticoagulant and Carotid Stenting

et al. 2020

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Objective: A rare case of thromboembolic cerebral infarction due to carotid web in a patient with congenital protein C deficiency is reported.Case Presentation: A patient in her 40's with left-side hemiparesis was transferred to our hospital under continuous intravenous injection of heparin. Magnetic resonance angiography demonstrated occlusion of the right middle cerebral artery (MCA). Conventional angiography revealed recanalization of the right MCA and a carotid web at the origin of the right internal carotid artery. Ultrasound scan of the carotid artery on the 19th day revealed thrombus formation on the distal portion of the carotid web. We performed carotid artery stenting to prevent thrombus formation by suppressing the carotid web to the vessel wall and by regulating the turbulent flow. The patient had no recurrence of stroke under-anticoagulation with warfarin during the 2-year follow-up period.Conclusion: To our knowledge, this is the first report in which an immediate thrombus formation on the carotid web was observed in a patient with congenital protein C deficiency. In a case of acute ischemic stroke with carotid web, especially when congenital coagulopathy such as protein C deficiency is suspected, careful follow-up with ultrasound imaging should be performed.

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“…Carotid web is pathologically defined as an intimal variant of fibromuscular dysplasia, which appears radiographically as a shelf-like filling defect on the posterior aspect at the origin of the internal carotid artery (ICA). [1][2][3] Available literature indicates that carotid web leads to ischemic stroke in young patients (aged <60 years) without any other cause of stroke. 1,3 Hemodynamic changes such as blood flow stasis and turbulence in the rostral aspect of the carotid web result in thrombus formation and dislodgement, which can provoke artery-to-artery embolism to the anterior circulation.…”

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confidence: 99%

“…[1][2][3] Available literature indicates that carotid web leads to ischemic stroke in young patients (aged <60 years) without any other cause of stroke. 1,3 Hemodynamic changes such as blood flow stasis and turbulence in the rostral aspect of the carotid web result in thrombus formation and dislodgement, which can provoke artery-to-artery embolism to the anterior circulation. 2 In the subanalysis of the multicenter randomized trial of endovascular treatment for acute ischemic stroke in the Netherlands (MR CLEAN) trial, the incidence of carotid web was 2.5% ipsilateral to index stroke.…”

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confidence: 99%