Recurrent transient ischemic attacks and stroke in association with an internal carotid artery web.

Abstract

Fibromuscular dysplasia is a nonatherosclerotic vascular disease that most commonly affects cervical carotid arteries at the C1-C2 level when cephalic arteries are involved. Several histopathologic and angiographic subtypes of fibromuscular dysplasia exist; most have a benign natural history. We describe the third reported case of a pathologically proven, symptomatic proximal internal carotid artery web and suggest that patients with this lesion are at a higher risk for stroke. (Stroke 1991;22:94-98)

Carotid Webs and Recurrent Ischemic Strokes in the Era of CT Angiography

“…Fibrous intimal thickening noted in our specimens may be a feature of the intimal variant of fibromuscular dysplasia in the internal carotid artery. 12,13,15,16 The intimal shelf observed in 1 of our patients has been previously described as an intimal variant of FMD. 16 It is also possible that the various forms of asymmetric fibrous intimal cushions observed in the other 3 patients in our study represent part of the spectrum of intimal FMD in the internal carotid artery.…”

“…5,7 With a few exceptions, 5,7-10 previous reports of carotid web descriptions relied on conventional angiography. 1,3,[11][12][13][14][15] The MRA appearance of the carotid web is expected to be similar to that on CTA, though this needs to be studied. Endarterectomy performed for atherosclerotic carotid stenosis typically produces a specimen with a classic atheroma, characterized by a large necrotic lipid-rich core covered by a fibrous cap.…”

Vascular neck bruit in a teenager

“…The prevalence of carotid web and the likelihood of subsequent thrombus formation are unknown [2]. It is likely that the intraluminal web produces a low-grade obstruction that may disturb flow and may serve as a focus for thrombus formation, with subsequent embolisation of a thrombus leading to transient ischaemic attack, stroke or even death [3,4].…”

Carotid-Bulb Atypical Fibromuscular Dysplasia in Young Afro-Caribbean Patients With Stroke

“…CTA anomalies may also be subtle or confused with plaque. However, some images evoked CaFMD: a thin 2,6,7 or thick 8 spur, located on the posterolateral side of the bulb, megabulb appearance 2 and no carotid calcification. Moreover, the absence of vascular risk factors in 68% of our young patients is not suggestive of atherosclerosis.…”

“…2 Curiously, all but one 5 report on CaFMD are not recent, which might explain our suboptimal knowledge about this cause of stroke affecting the young and potentially recurrent. 6,7 Because Martinique, a French West Indies island, is inhabited mostly by Afro-Caribbeans, we expected to find CaFMD responsible for ischemic strokes in young Martinicans. Therefore, we systematically sought CaFMD in young patients with stroke.…”