Elmokadem A H, Ansari S A, Sangha R, Prabhakaran S, Shaibani A, Hurley M C
Department of Radiology, Mansoura University, Egypt Department of Radiology, Northwestern University Feinberg School of Medicine, USA
Department of Radiology, Northwestern University Feinberg School of Medicine, USA Department of Neurology, Northwestern University Feinberg School of Medicine, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA.
Interv Neuroradiol. 2016 Aug;22(4):432-7. doi: 10.1177/1591019916633245. Epub 2016 Feb 27.
A carotid web can be defined as an endoluminal shelf-like projection often noted at the origin of the internal carotid artery (ICA) just beyond the bifurcation. Diagnosis of a carotid web as an underlying cause of recurrent ischemic stroke is infrequent and easily misdiagnosed as an atheromatous plaque. Surgery has traditionally been used to resect symptomatic lesions while there is no enough evidence supporting medical therapy as the sole management. To our knowledge there is only one report about carotid artery stenting (CAS) as a definite management of carotid web and no previous reports of acute large-vessel occlusions undergoing mechanical thrombectomy in the setting of carotid web as the etiology.
We report two cases: The first presented with recurrent ischemic stroke in the same arterial territory and the other with an emergent left middle cerebral artery (MCA) occlusion that underwent endovascular mechanical thrombectomy in which initial computed tomographic angiograms (CTA) suggested carotid web etiologies. Following confirmation with digital subtraction angiography (DSA), both patients ultimately underwent endovascular carotid stenting instead of surgical resection for definitive carotid web treatment.
Carotid webs are a rare cause of ischemic stroke in young and middle-aged adults that can readily be identified by CTA. Endovascular management may include emergent mechanical thrombectomy for large-vessel thromboembolic complications, and for definitive treatment with carotid stenting across the carotid web as an alternative to surgical resection and medical management for secondary stroke prevention.
颈动脉嵴可定义为一种腔内 shelf 样突起，常在颈内动脉（ICA）起源处、刚好位于分叉部远端被发现。将颈动脉嵴诊断为复发性缺血性卒中的潜在病因并不常见，且容易被误诊为动脉粥样硬化斑块。传统上，手术用于切除有症状的病变，而目前尚无足够证据支持将药物治疗作为唯一的治疗方法。据我们所知，仅有一篇关于颈动脉支架置入术（CAS）作为颈动脉嵴明确治疗方法的报告，且此前尚无在颈动脉嵴作为病因的情况下，急性大血管闭塞接受机械取栓治疗的报告。
我们报告两例病例：第一例表现为同一动脉区域的复发性缺血性卒中，另一例为急性左大脑中动脉（MCA）闭塞，接受了血管内机械取栓治疗，最初的计算机断层血管造影（CTA）提示病因是颈动脉嵴。经数字减影血管造影（DSA）确认后，两名患者最终均接受了血管内颈动脉支架置入术，而非手术切除，以进行颈动脉嵴的确定性治疗。
颈动脉嵴是中青年缺血性卒中的罕见病因，CTA 可轻易识别。血管内治疗可能包括对大血管血栓栓塞并发症进行紧急机械取栓，以及通过跨越颈动脉嵴的颈动脉支架置入术进行确定性治疗，作为手术切除和药物治疗预防继发性卒中的替代方法。
