Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
Department of Radiology, Amsterdam University Medical Centres, Duivendrecht, Noord-Holland, The Netherlands.
J Neurol Neurosurg Psychiatry. 2020 Dec;91(12):1283-1289. doi: 10.1136/jnnp-2020-323938. Epub 2020 Oct 1.
The carotid web is a proposed stroke mechanism that may underlie cryptogenic stroke, particularly in younger patients without vascular risk factors. The web appears as a shelf-like projection into the lumen of the proximal cervical internal carotid artery without evidence of calcification. It is pathologically defined as intimal fibromuscular dysplasia. Altered haemodynamics distal to the web cause flow stagnation and remote embolisation of fibrin-based clots. It is best demonstrated and diagnosed on CT angiography (CTA) of the neck because of its ability to resolve calcium and create multiplanar reconstructions. Although they can be readily visualised on CTA, carotid webs may be missed or misinterpreted because they do not typically cause haemodynamically significant stenosis and can mimic arterial dissection, non-calcified atherosclerotic plaque and intraluminal thrombus. Options for management include antiplatelet therapy, carotid endarterectomy and carotid artery stenting. Modern management strategies for cryptogenic stroke include long-term cardiac monitoring, further investigation for structural cardiac disease and a diagnostic workup for arterial hypercoagulability, however, these strategies are not likely to capture the possibility of a carotid web. Carotid webs should be suspected in a young patient presenting with recurrent unihemispheric strokes particularly when conventional vascular risk factors are not present.
颈动脉膜是一种可能导致隐源性中风的中风机制，特别是在没有血管危险因素的年轻患者中。该膜表现为向颈内动脉近端管腔突出的架子状突起，没有钙化的证据。它在病理学上被定义为内膜纤维肌肉发育不良。膜下游的血液动力学改变导致血流停滞和基于纤维蛋白的血栓的远程栓塞。由于其能够解析钙并创建多平面重建，因此在颈部 CT 血管造影（CTA）上可以最佳地显示和诊断。尽管它们可以在 CTA 上轻松可视化，但颈动脉膜可能会被遗漏或误诊，因为它们通常不会导致血流动力学显著狭窄，并且可以模拟动脉夹层、非钙化粥样硬化斑块和管腔内血栓。治疗选择包括抗血小板治疗、颈动脉内膜切除术和颈动脉支架置入术。隐源性中风的现代管理策略包括长期心脏监测、进一步调查结构性心脏病以及动脉高凝状态的诊断性检查，然而，这些策略不太可能捕捉到颈动脉膜的可能性。当不存在常规血管危险因素时，年轻患者反复出现单侧半球性中风，应怀疑颈动脉膜。
