Department of Neurology, Emory University Hospital and Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia.
JAMA Neurol. 2019 Mar 1;76(3):355-361. doi: 10.1001/jamaneurol.2018.3366.
A succession of research has explored the linkage between carotid webs (CaWs) and ischemic strokes. Imaging and pathologic analysis have defined CaW as an intimal variant of fibromuscular dysplasia, which appears as a shelflike lesion on the posterior aspect of the carotid bulb, more specifically at the origin of internal carotid artery. Reported findings of carotid webs in young patients with recurrent ischemic strokes without an otherwise determined cause have raised questions about the mechanism, natural history, and need for intervention. This review addresses the current understanding of CaW and highlights findings that prompt further investigation into this unique vascular entity as a modifiable stroke risk factor.
Imaging analysis demonstrates hemodynamic disturbance in the presence of CaWs. The protuberant shelflike structure creates a pocket therein that may subsequently lead to local thrombosis and cerebral embolism. Computed tomographic angiography is an accurate and often used noninvasive diagnostic modality. Although treatment paradigms have not been systematically evaluated, antiplatelet monotherapy may not be sufficient to reduce recurrent ischemic events in the small series of patients with stroke and symptomatic CaWs.
The limited clinical data on CaWs, although complicated by selection bias, suggest an increased prevalence of these vascular entities in cerebral ischemic events among patients younger than 60 years. Imaging suggests CaW to be a possible nidus for cerebral thromboembolism. Physicians should consider CaW as a cause of stroke in younger patients with anterior circulation ischemic strokes of an otherwise undetermined cause. Treatment options in CaWs with ischemic strokes have not been extensively investigated. Multicenter observational studies evaluating the natural history of CaW are warranted.
一系列研究探讨了颈动脉壁（CaW）与缺血性中风之间的联系。影像学和病理学分析将 CaW 定义为纤维肌性发育不良的内膜变异，表现为颈动脉球后侧面的架子状病变，更具体地说是在颈内动脉的起源处。在没有其他确定原因的年轻复发性缺血性中风患者中报告的颈动脉壁发现，引发了关于机制、自然病史和干预必要性的问题。这篇综述介绍了目前对 CaW 的理解，并强调了一些发现，这些发现促使人们进一步研究这种独特的血管实体作为可改变的中风风险因素。
影像学分析表明 CaWs 存在血液动力学紊乱。突出的架子状结构在其中形成一个口袋，随后可能导致局部血栓形成和脑栓塞。计算机断层血管造影是一种准确且常用的非侵入性诊断方式。尽管尚未系统评估治疗方案，但在有中风和症状性 CaW 的小系列患者中，抗血小板单药治疗可能不足以减少复发性缺血事件。
尽管存在选择偏倚，但关于 CaW 的有限临床数据表明，这些血管实体在 60 岁以下的脑缺血事件中更为普遍。影像学提示 CaW 可能是脑血栓栓塞的一个潜在病灶。医生应将 CaW 视为年轻患者发生不明原因前循环缺血性中风的原因之一。在 CaW 合并缺血性中风的治疗选择尚未得到广泛研究。评估 CaW 自然病史的多中心观察性研究是必要的。
