Department of Neurology, Emory University School of Medicine/Grady Memorial Hospital Marcus Stroke and Neuroscience Center. Atlanta, Georgia, GA 30303, USA.
Department of Neurology, Emory University School of Medicine/Grady Memorial Hospital Marcus Stroke and Neuroscience Center. Atlanta, Georgia, GA 30303, USA.
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105333. doi: 10.1016/j.jstrokecerebrovasdis.2020.105333. Epub 2020 Oct 17.
Carotid web is a radiographic entity located in the posterior aspect of the origin of the internal carotid arteries, considered to be a pathologic equivalent to intimal fibromuscular dysplasia, and has been implicated in acute ischemic strokes. The mechanism underlying its development is unknown and it remains unclear if this lesion is congenital or acquired. The aim of our study was to determine the frequency of carotid webs in a pediatric population with acute ischemic stroke (AIS).
A retrospective review of neck CTA, MRA, or DSA images in a pediatric population with acute ischemic stroke was performed to determine the occurrence of carotid webs. Two fellowship-trained neurointerventionists performed independent vascular imaging review.
We identified forty-seven cases of childhood acute ischemic stroke (55% male; median age, 9 years). Congenital heart disease, sickle cell disease, infection, and recent head/neck trauma were the most common risk factors. Eight of the ischemic stroke cases were located in multiple vascular territories. Neck arterial imaging was undertaken in twenty-four patients. No carotid webs were detected in the studied pediatric stroke population. (The correlation coefficient for the determination of webs was Kappa = 1.00; p < 0.001).
This study failed to find evidence that carotid webs are congenital. More studies are needed for a better understanding of carotid web origin, natural evolution, and the potential implications for treatment.
颈动脉壁是一种位于颈内动脉起始后段的影像学实体，被认为是血管内膜纤维肌发育不良的病理学等价物，并与急性缺血性脑卒中有关。其发病机制尚不清楚，目前尚不清楚该病变是先天性的还是后天获得的。我们的研究目的是确定急性缺血性脑卒中（AIS）患儿中颈动脉壁的发生率。
对急性缺血性脑卒中患儿的颈部 CTA、MRA 或 DSA 图像进行回顾性分析，以确定颈动脉壁的发生情况。由两名神经介入培训研究员进行独立的血管成像复查。
我们确定了 47 例儿童急性缺血性脑卒中（55%为男性；中位年龄为 9 岁）。先天性心脏病、镰状细胞病、感染和近期头颈部外伤是最常见的危险因素。8 例缺血性脑卒中位于多个血管区域。24 例患者进行了颈部动脉成像。在研究的儿科脑卒中人群中未发现颈动脉壁。（用于确定壁的相关性系数 Kappa=1.00；p<0.001）。
本研究未能发现颈动脉壁为先天性的证据。需要更多的研究来更好地了解颈动脉壁的起源、自然演变及其对治疗的潜在影响。
