Endarterectomy for a symptomatic carotid web

Phair, John P.; Trestman, Eric B.; Yean, Chetra; Lipsitz, Evan C.

doi:10.1177/1708538116684940

Cited by 20 publications

(19 citation statements)

References 9 publications

(19 reference statements)

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“…Some have advocated the use of anticoagulation based on the fact that the mechanism of stroke is due to stasis-induced thrombosis, similar to that seen in strokes related to atrial fibrillation. Others have advocated for the use of endarterectomy to resect the web or carotid stenting [3, 7]. In a series of 25 patients with symptomatic carotid webs, Joux et al [3] performed endarterectomy in 7 cases with no cases of stroke recurrence or complications.…”

Section: Discussionmentioning

confidence: 99%

Carotid Stenting for Treatment of Symptomatic Carotid Webs: A Single-Center Case Series

2018

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Background and Purpose: Carotid webs are an increasingly recognized cause of acute ischemic stroke, particularly in younger adults. The optimal medical and surgical strategies for managing these lesions have not been well established. We report a single-center case series of carotid stenting for treatment of symptomatic carotid webs. Materials and Methods: Consecutive patients undergoing stent placement for treatment of symptomatic carotid webs were included. Carotid webs were defined as a thin intraluminal filling defect along the posterior wall of the carotid bulb just beyond the carotid bifurcation on CTA. Data were collected on demographic characteristics, antiplatelet management, clinical presentation, imaging findings, treatment characteristics, complications, and stroke recurrence rates. Descriptive statistics are reported. Results: A total of 4 patients were treated. Their mean age was 44 years (range 30–50). Three patients were female and 1 was male. All patients were symptomatic presenting with ipsilateral transient ischemic attacks or stroke. Patients were placed on dual antiplatelet therapy with ticagrelor and aspirin prior to the procedure. There were no ischemic or hemorrhagic complications. Three patients had postoperative bradycardia, 1 of whom required atropine immediately following stenting. No patients had recurrent ischemic events. Conclusions: Stent placement for treatment of carotid webs can be performed safely. Further studies are needed to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

Carotid Stenting for Treatment of Symptomatic Carotid Webs: A Single-Center Case Series

2018

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“…Subsequently, relevant studies on carotid webs were reported [ 1 – 5 ], which suggested that carotid webs are thin membrane structures protruding into the lumen; they are more common in the posterior or lateral posterior wall of the internal carotid bulb, and are approximately eight times more common in patients with stroke than in controls. Moreover, carotid webs are strongly associated with ischemic stroke [ 3 , 8 ], and they are one of the causes of cryptogenic stroke in young patients [ 1 , 4 , 10 , 15 ]. However, they are often missed [ 11 ] and could be an underappreciated risk factor for stroke [ 4 , 9 ].…”

Section: Resultsmentioning

confidence: 99%

“…[ 14 ] described carotid webs using DUS in 1991 and 2004, respectively, and another case of carotid web by DUS was reported in 2015 [ 11 ]. While almost all diagnoses and reports on this disease were based on CTA or digital subtraction angiography, a study in 2017 using DUS reported on a carotid web with a short segment filling defect [ 15 ]. Thus, DUS could make an accurate diagnosis and may have the ability to diagnose carotid web.…”

Section: Resultsmentioning

confidence: 99%

“…Its diagnosis is a challenge for radiologists and sonographers because it is rare and relevant reports are scarce, which in turn affects the treatment and management of the disease. Although previous reports of carotid web exist [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], carotid webs with atherosclerotic plaque formation have not been mentioned in previous studies. Thus, establishing the image characteristics of this disease is vital to improve treatment and outcomes.…”

Section: Introductionmentioning

confidence: 89%

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Ultrasound imaging of carotid web with atherosclerosis plaque: a case report

et al. 2020

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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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“…13 Phair et al helped to distinguish carotid webs from FMD when they reported a patient presenting with an M1 occlusion whose CTA and MRI initially showed a filling defect at the right carotid artery bifurcation without a readily identifiable web. 16 Upon treatment with endarterectomy, a carotid web was seen, and histopathology showed smooth muscle with extensive myxoid degenerative changes, as opposed to the medial fibroplasia and loose collagen seen in FMD. 14 Although no studies compare endarterectomy vs stenting for treatment of a carotid web, we can extrapolate the data from carotid stenosis in which minimal risk is associated with carotid stenting using new stent technologies, 17,18 especially if performed after the first week from symptom presentation.…”

Section: Figure 3 Digital Subtraction Angiography Of Injections Of Tmentioning

confidence: 99%