MR imaging of carotid webs

Boesen, Mari E.; Eswaradass, Prasanna Venkatesan; Singh, Dilip; Mitha, Alim P.; Goyal, Mayank; Frayne, Richard; Menon, Bijoy K

doi:10.1007/s00234-017-1797-z

Cited by 41 publications

(25 citation statements)

References 6 publications

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“…Interobserver agreement for identification of webs on CTA is high with kappa values over 0.90 [2]. Examination of these lesions with vessel wall imaging shows focal vessel wall thickening with a thin fibrous band and no enhancement, plaque hemorrhage or other atherosclerosis-type characteristics [5]. One such example of wall imaging is provided in Figure 3.…”

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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“…The particular morphology of CaW leads to blood stasis in the rostral aspect of the lesion, which leads to thrombosis, as previously documented by histology, CTA, and conventional angiography [2,[6][7][8]. Superimposed thrombosis has been reported in 29-40% of patients with CaW-related strokes and leads to cerebral embolism [2,6].…”

Section: Discussionmentioning

confidence: 79%

Multicenter Experience with Stenting for Symptomatic Carotid Web

Haussen¹,

Grossberg²,

Koch³

et al. 2018

Intervent Neurol

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Background: A carotid web (CaW) is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. CaW has been associated with recurrent strokes and conventionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic CaWs. Methods: Retrospective review of consecutive patients admitted to 5 comprehensive stroke centers who were identified to have a symptomatic CaW and treated with carotid stenting. A symptomatic CaW was defined by the presence of a shelf-like/linear, smooth filling defect in the posterior aspect of the carotid bulb diagnosed by neck CT angiography (CTA) and confirmed with conventional angiography in patients with negative stroke workup. Results: Twenty-four patients with stented symptomatic CaW were identified (stroke in 83% and transient ischemic attack in 17%). Their median age was 47 years (IQR 41–61), 14 (58%) were female, and were 17 (71%) black. The degree of stenosis by NASCET was 0% (range 0–11). All patients were placed on dual antiplatelets and stented at a median of 9 days (IQR 4–35) after the last event. Closed-cell stents were used in 18 (75%) of the cases. No periprocedural events occurred with the exception of 2 cases of asymptomatic hypotension/bradycardia. Clinical follow-up after stent placement occurred for a median of 12 months (IQR 3–19) with no new cerebrovascular events noted. Functional independence at 90 days was achieved in 22 (91%) patients. Follow-up vascular imaging (ultrasound n = 18/CTA n = 5) was performed at a median of 10 months (IQR 3–18) and revealed no stenosis. Conclusions: Stenting for symptomatic CaW appears to be a safe and effective alternative to surgical resection. Further studies are warranted.

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“…Compared to CTA, magnetic resonance imaging (MRI) may emerge as a reliable tool to diagnose and characterize carotid webs in more detail, detecting smaller lesions as well as evaluating wall composition, biomechanics, and flow dynamics over time. 14 Carotid bulb lesions were evaluated in a study of Afro-Caribbean stroke patients for a 5-year period. 6 In this study, 25 patients were identified by CTA as having atypical FMD of the carotid bulb (CaFMD).…”

Section: Discussionmentioning

confidence: 99%

“…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. 19…”

Section: Figure 3 Digital Subtraction Angiography Of Injections Of Tmentioning

confidence: 99%

Carotid Web Stenting

Gouveia

Mathkour

Bennett

et al. 2019

TOJ

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MR imaging of carotid webs

Abstract: Our MR imaging protocol enables an in-depth evaluation of patients with carotid webs: morphology (by MRA), composition (by multi-contrast FSE), and wall dynamics (by cineFSE).

Cited by 41 publications

References 6 publications

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

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

Multicenter Experience with Stenting for Symptomatic Carotid Web

Carotid Web Stenting

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