Department of Neurology, First Hospital of Jilin University, Changchun, China.
Department of Radiology, First Hospital of Jilin University, Changchun, China.
Vascular. 2023 Aug;31(4):699-707. doi: 10.1177/17085381221084809. Epub 2022 Mar 19.
The carotid web is a compelling potential mechanism of cryptogenic stroke. It is easy for it to escape diagnosis or be misdiagnosed, since it rarely causes hemodynamic stenosis. Currently, there is a lack of consensus on the prevalence, etiology, imaging evaluation, and treatment strategy of carotid artery. We aimed to present the multimodal imaging of carotid web and comprehensively review the characteristics of carotid web.
A 38 year-old man with carotid web, who presented with acute left hemispheric syndrome, was not identified by computed tomography angiography and high-resolution magnetic resonance imaging in the initial report, but were identified in retrospect and then confirmed by digital subtraction angiography and histopathology. A literature review of carotid web was performed to identify prevalence, nature history, imaging tools, and optimal management of carotid web.
80 reports including 681 patients with carotid web were identified. The prevalence of symptomatic carotid web was 1.2% in patients with transient ischemic attack/stroke, 6.4% in patients with cryptogenic ischemic stroke, 1.1% in patients with large vessel occlusion stroke, and 4.4% in patients who operated on for carotid stenosis. A total of 23.0% patients had bilateral carotid web. In most patients, carotid web was located on the posterior wall (87.3%) of the carotid artery (98.7%). The mean length was 3.3 mm and mean stenosis rate was 20.9%. A total of 31.6% percent patients had thrombus trapped in carotid web and 75.9% patients had large vessel occlusion. Computed tomography angiography and digital subtraction angiography were favorable tools to detect carotid web. There were rare periprocedural complications and no recurrent strokes in carotid revascularization patients.
carotid web is an under-recognized cause of ischemic stroke. It is easy to be missed or misdiagnosed. Carotid revascularization can effectively prevent recurrent stroke for patients with symptomatic carotid web. Clinicians should strength their learning and understanding of carotid web.
颈动脉壁是引起隐源性卒中的一个潜在的重要原因。由于其很少引起血流动力学狭窄，因此很容易漏诊或误诊。目前，颈动脉的患病率、病因、影像学评估和治疗策略尚缺乏共识。我们旨在介绍颈动脉壁的多模态影像学表现，并全面回顾颈动脉壁的特征。
我们报告了一位 38 岁的男性患者，他患有颈动脉壁，表现为急性左侧半球综合征。在最初的报告中，计算机断层血管造影和高分辨率磁共振成像未能识别颈动脉壁，但在回顾性分析中识别出来，并通过数字减影血管造影和组织病理学证实。我们对颈动脉壁进行了文献回顾，以确定颈动脉壁的患病率、自然病史、影像学工具和最佳治疗方法。
共发现 80 篇文献，其中包括 681 例颈动脉壁患者。症状性颈动脉壁在短暂性脑缺血发作/卒中患者中的患病率为 1.2%，在隐源性缺血性卒中患者中的患病率为 6.4%，在大血管闭塞性卒中患者中的患病率为 1.1%，在接受颈动脉狭窄手术的患者中的患病率为 4.4%。共有 23.0%的患者存在双侧颈动脉壁。在大多数患者中，颈动脉壁位于颈动脉（98.7%）的后壁（87.3%）。平均长度为 3.3mm，平均狭窄率为 20.9%。共有 31.6%的患者颈动脉壁内有血栓形成，75.9%的患者存在大血管闭塞。计算机断层血管造影和数字减影血管造影是检测颈动脉壁的有利工具。颈动脉再通术患者围手术期并发症罕见，无复发性卒中。
颈动脉壁是缺血性卒中的一个未被充分认识的原因。它很容易被忽视或误诊。对于有症状的颈动脉壁患者，颈动脉再通术可有效预防复发性卒中。临床医生应加强对颈动脉壁的学习和理解。
