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NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1483-1484

The Pathogenic Mechanism of Carotid Web Causing the Recurrent Stroke


1 Department of Neurology, Beijing Geriatric Hospital, Beijing, China
2 Department of Neurology, LiShui People's Hospital, Zhejiang Province, China

Date of Submission13-Sep-2018
Date of Decision30-Sep-2018
Date of Acceptance02-Jan-2020
Date of Web Publication30-Oct-2021

Correspondence Address:
Tang Yanan
Department of Neurology, LiShui People's Hospital, 15 Dazong Street, Lishui - 323 000, Zhejiang Province
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.329610

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How to cite this article:
Zhiyong Z, Yanan T, Pugang L, Weiwen Q, Genlong Z, Lin X. The Pathogenic Mechanism of Carotid Web Causing the Recurrent Stroke. Neurol India 2021;69:1483-4

How to cite this URL:
Zhiyong Z, Yanan T, Pugang L, Weiwen Q, Genlong Z, Lin X. The Pathogenic Mechanism of Carotid Web Causing the Recurrent Stroke. Neurol India [serial online] 2021 [cited 2021 Nov 30];69:1483-4. Available from: https://www.neurologyindia.com/text.asp?2021/69/5/1483/329610




A 59-year-old man without cardiovascular risk factors was admitted to emergency department with acute right hemispheric syndrome. Cerebrovascular imaging showed total occlusion of M1 segment of right middle cerebral artery (MCA). He accepted combination therapy of intravenous thrombolysis and mechanical thrombectomy inside the therapeutic time window. After the bridge therapy, the MCA was completely recanalized and his clinical symptoms were partially improved. Interestingly, catheter angiography revealed a shelf-like intraluminal filling defect in the ipsilateral internal carotid bulb compatible with carotid web and a hidden thrombus under the web [Figure 1]a. Because the complete reperfusion of right MCA was obtained, we decided to choose elective surgery to the carotid web and thrombus. Doppler ultrasound showed that the unstable thrombus was getting smaller after 3 days [Figure 1]b. Unfortunately, the same symptoms recurred 5 days later. The subsequent CTA showed that the MCA was reoccluded [Figure 1]c, and the thrombus disappeared [Figure 1]d.
Figure 1: (a) Digital subtraction angiography demonstrating the carotid web and thrombus (arrow). (b) Doppler ultrasound showing the unstable thrombus getting smaller (arrow). (c and d) Computed tomography angiography showing the reoccluded right middle cerebral artery (MCA) and disappeared thrombus (arrows)

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It is reported that there are many causes of recurrent stroke, and carotid web may be one of them.[1],[2],[3],[4] Carotid web is an intraluminal projection of arterial wall, mostly localized in the posterior wall of internal carotid bulb.[3] Most carotid webs have no marked narrowing; however, the specific membrane-like structure may create turbulent flow leading to blood stasis and thrombus formation, giving rise to thromboembolic stroke.[4] But this pathogenesis is speculative; the exact pathogenic mechanism is unclear. The sequential neuroimages from our case demonstrably confirmed that the etiopathogenic mechanism of the recurrent stroke was thromboembolism from carotid web.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kang K, Lee WW, Kwon O, Kim BK. Unilateral arm flapping gait as a manifestation of synkinesis following recurrent strokes. Neurol India 2018;66:1493-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sharma SR, Habung H, Hussain M. Churg-Strauss syndrome in a pediatric patient presenting with recurrent hemorrhagic stroke and mitral regurgitation due to a prolapsed mitral valve. Neurol India 2016;64:827-30.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Haussen DC, Grossberg JA, Bouslama M, Pradilla G, Belagaje S, Bianchi N, et al. Carotid web (Intimal Fibromuscular Dysplasia) has high stroke recurrence risk and is amenable to stenting. Stroke 2017;48:3134-7.  Back to cited text no. 3
    
4.
Choi PM, Singh D, Trivedi A, Qazi E, George D, Wong J, et al. Carotid webs and recurrent ischemic strokes in the era of CT angiography. AJNR Am J Neuroradiol 2015;36:2134-9.  Back to cited text no. 4
    


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