Emilio Rodríguez-Castro1, Susana Arias-Rivas2, María Santamaría-Cadavid2, Iria López-Dequidt2, Manuel Rodríguez-Yáñez2, Antonio Jesús Mosqueira3, Miguel Blanco Ulla3, Fernando Vázquez Herrero3, José Antonio Castiñeira3, Elena Martínez-Sáez4, Edurne Pérez Béliz5, Nilo Mosquera6, Diego Caicedo6, Máximo Fraga5,7, José Manuel Pumar3,8,9. 1. Stroke Unit, Department of Neurology, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa Travesa da Choupana, s/n, 15706, Santiago de Compostela, Spain. emiliorcastro@gmail.com. 2. Stroke Unit, Department of Neurology, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa Travesa da Choupana, s/n, 15706, Santiago de Compostela, Spain. 3. Department of Neuroradiology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain. 4. Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain. 5. Department of Pathology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain. 6. Department of Angiology and Vascular Surgery, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain. 7. Department of Forensic Sciences, Pathology, Gynecology and Obstetrics, and Pediatrics, Faculty of Medicine of Santiago de Compostela, Santiago de Compostela, Spain. 8. President of Sociedad Íbero Latino Americana de Neurorradiología Diagnóstica y Terapéutica (SILAN), Barcelona, Spain. 9. Chair of Interventional Neuroradiology of the University of Santiago de Compostela (CINIUS), Santiago de Compostela, Spain.
Abstract
BACKGROUND: Determining the cause of acute ischemic stroke is crucial for patient management, particularly for preventing future stroke. In recent years, carotid web (CW), a non-atherosclerotic disorder of the carotid wall, has been found to be an underestimated source of cerebral emboli. OBJECTIVE: The present study aimed to analyze the clinical, radiological, and pathological findings, along with the treatments performed in patients with CW and ipsilateral ischemic events. METHODS: Patients with anterior circulation ischemic stroke or transient ischemic attack and ipsilateral CW were prospectively included from January 2019 to December 2021. RESULTS: Nine patients were enrolled. The median age was 55 (43-62) years, with a female-to-male ratio of 3.5:1. Of the total, seven patients (78%) consulted for recurrent ipsilateral ischemic events. Despite medical treatment, 44% of the patients experienced new episodes. Computed tomographic angiography was suggestive of CW in all cases in which it was performed. The interval between the first ischemic event and diagnosis of CW was of 13 (6-68) months. After ruling out any other possible etiology, every patient underwent carotid revascularization, one underwent stenting and eight underwent carotidectomy. No severe or long-term complications were noted. Histological studies confirmed the diagnosis of CW. There were no recurrences after carotid revascularization during a follow-up of 24 (13-35) months. CONCLUSION: Knowledge of CW and differentiating it from atheroma plaques is essential, as medical management seems to be insufficient in many cases. Revascularization, which has been shown to be safe and effective, might be the best treatment modality.
BACKGROUND: Determining the cause of acute ischemic stroke is crucial for patient management, particularly for preventing future stroke. In recent years, carotid web (CW), a non-atherosclerotic disorder of the carotid wall, has been found to be an underestimated source of cerebral emboli. OBJECTIVE: The present study aimed to analyze the clinical, radiological, and pathological findings, along with the treatments performed in patients with CW and ipsilateral ischemic events. METHODS: Patients with anterior circulation ischemic stroke or transient ischemic attack and ipsilateral CW were prospectively included from January 2019 to December 2021. RESULTS: Nine patients were enrolled. The median age was 55 (43-62) years, with a female-to-male ratio of 3.5:1. Of the total, seven patients (78%) consulted for recurrent ipsilateral ischemic events. Despite medical treatment, 44% of the patients experienced new episodes. Computed tomographic angiography was suggestive of CW in all cases in which it was performed. The interval between the first ischemic event and diagnosis of CW was of 13 (6-68) months. After ruling out any other possible etiology, every patient underwent carotid revascularization, one underwent stenting and eight underwent carotidectomy. No severe or long-term complications were noted. Histological studies confirmed the diagnosis of CW. There were no recurrences after carotid revascularization during a follow-up of 24 (13-35) months. CONCLUSION: Knowledge of CW and differentiating it from atheroma plaques is essential, as medical management seems to be insufficient in many cases. Revascularization, which has been shown to be safe and effective, might be the best treatment modality.
Authors: Jonathan M Coutinho; Sheldon Derkatch; Alphonse R J Potvin; George Tomlinson; Tim-Rasmus Kiehl; Frank L Silver; Daniel M Mandell Journal: Neurology Date: 2016-07-13 Impact factor: 9.910
Authors: Mayank Goyal; Nishita Singh; Martha Marko; Michael D Hill; Bijoy K Menon; Andrew Demchuk; Shelagh B Coutts; Mohammed A Almekhlafi; Johanna M Ospel Journal: Stroke Date: 2020-03-06 Impact factor: 7.914
Authors: Jonathan M Coutinho; Sheldon Derkatch; Alphonse R J Potvin; George Tomlinson; Leanne K Casaubon; Frank L Silver; Daniel M Mandell Journal: Neurology Date: 2016-11-18 Impact factor: 9.910
Authors: Johanna M Ospel; Nishita Singh; Martha Marko; Mohammed Almekhlafi; Dar Dowlatshahi; Josep Puig; Andrew Demchuk; Shelagh B Coutts; Michael D Hill; Bijoy K Menon; Mayank Goyal Journal: Stroke Date: 2020-05-07 Impact factor: 7.914
Authors: Robert G Hart; Hans-Christoph Diener; Shelagh B Coutts; J Donald Easton; Christopher B Granger; Martin J O'Donnell; Ralph L Sacco; Stuart J Connolly Journal: Lancet Neurol Date: 2014-04 Impact factor: 44.182