Department of Neurology, Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia.
Department of Neurology, Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia.
J Stroke Cerebrovasc Dis. 2019 Dec;28(12):104402. doi: 10.1016/j.jstrokecerebrovasdis.2019.104402. Epub 2019 Sep 26.
Young individuals with symptomatic carotid webs may be predisposed to ischemic strokes. However, evidence remains scarce. This investigation reports the frequency of carotid webs among patients with cryptogenic strokes compared to a control group.
Consecutive cryptogenic ischemic strokes and trauma patients were identified. Additional inclusion criteria required age 18-60 years and availability of head/neck computed tomography (CT) angiography. CT angiogram (CTA) neck images were evaluated independently by 2 fellowshiptrained specialists. A carotid web was defined by a shelf-like, linear filling defect in the posterior internal carotid artery bulb.
Of 1877 patients presenting with ischemic strokes in 2015-2017, 165 were diagnosed with cryptogenic strokes, 51 of whom met the inclusion criteria of age and CTA availability. Fifty one trauma cases were matched for age and sex. After imaging analysis, 13 carotid webs (25%) were identified in the 51 cryptogenic stroke group versus 0 (0%; P < .001) in trauma subjects. Thirty-nine of the 51 cryptogenic ischemic stroke patients were found with carotid anterior distribution infarcts, of which 9 (23%) were found with ipsilateral carotid webs. There were more proximal large vessel occlusions in the cryptogenic patients with carotid webs, compared to those without (P = .04). All carotid webs led to less than 30% degree of stenosis.
Carotid webs were found at a significantly higher frequency in patients with cryptogenic ischemic strokes compared to controls, indicating a potentially thrombogenic nature of these lesions in young patients. Additionally, intracranial large vessel occlusions were more common in patients with symptomatic carotid webs, presenting with ipsilateral strokes.
有症状颈动脉壁的年轻个体可能易患缺血性中风。然而，证据仍然很少。本研究报告了与对照组相比，隐源性中风患者中颈动脉壁的频率。
连续确定隐源性缺血性中风和创伤患者。额外的纳入标准要求年龄为 18-60 岁，且可获得头部/颈部计算机断层扫描（CT）血管造影。由 2 名受过专业培训的研究员独立评估 CT 血管造影（CTA）颈部图像。颈动脉壁定义为后内颈动脉球部的线性线性充盈缺损。
在 2015-2017 年期间，1877 名患有缺血性中风的患者中，有 165 名被诊断为隐源性中风，其中 51 名符合年龄和 CTA 可用性的纳入标准。51 例创伤病例按年龄和性别匹配。在成像分析后，在 51 例隐源性中风组中发现了 13 个颈动脉壁（25%），而在创伤组中则没有（0%；P<.001）。在 51 名隐源性缺血性中风患者中有 39 名患者发现颈动脉前分布梗死，其中 9 名（23%）患者同侧颈动脉壁。与无颈动脉壁的患者相比，有颈动脉壁的隐源性患者中更常见近端大血管闭塞（P=0.04）。所有颈动脉壁导致的狭窄程度均小于 30%。
与对照组相比，隐源性缺血性中风患者中颈动脉壁的发生率明显更高，表明这些年轻患者的病变具有潜在的血栓形成性质。此外，有症状颈动脉壁的患者中颅内大血管闭塞更为常见，表现为同侧中风。
