Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Emergency and Critical Care Center, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107998. doi: 10.1016/j.jstrokecerebrovasdis.2024.107998. Epub 2024 Sep 5.
A 48-year-old man with no history of diagnosis with any abnormality was admitted to our hospital 43 min after onset of stroke. He had a right conjugate deviation and severe left hemiparesis, and his initial National Institutes of Health Stroke Scale (NIHSS) score was 13. Computed tomography (CT) of the head revealed no early ischemic changes, while CT angiography showed occlusion of the M1 proximal segment of the right middle cerebral artery. Intravenous thrombolysis was administered within 27 min of admission, and mechanical thrombectomy was performed. Effective reperfusion was achieved 55 min after puncture. Carotid web (CaW) at the root of the right internal carotid artery was suspected to be the source of the embolus. Carotid ultrasonography (CUS) on the following day revealed an oval-shaped structure of equal intensity rising from the far wall. The structure enlarged over time, despite the administration of an antiplatelet agent. In addition to thrombi, intramural hematoma and neoplastic lesions were considered in the differential diagnosis. Carotid endarterectomy was performed on day 6. Pathologically, a mixed thrombus was identified adhering to the CaW; however, no neoplastic changes were observed. There were no postoperative complications, and the patient was discharged without neurological deficits on day 14. The CaW has anatomical factors morphologically associated with a high risk of thrombus formation. Pathologically, the involvement of hydrodynamic factors was considered more significant than the influence of the CaW surface morphology. CUS is a useful tool for assessing thrombus morphology.
一位 48 岁的男性，既往无任何异常诊断史，在发病后 43 分钟被收入我院。他有右侧共轭性偏斜和严重的左侧偏瘫，初始 NIHSS 评分为 13 分。头部 CT 未见早期缺血性改变，而 CT 血管造影显示右侧大脑中动脉 M1 近段闭塞。发病后 27 分钟内给予了静脉溶栓治疗，并进行了机械取栓。穿刺后 55 分钟达到有效再灌注。怀疑右侧颈内动脉根部的颈动脉壁（CaW）是栓子的来源。次日颈动脉超声（CUS）显示从远壁上升的等强度椭圆形结构。尽管给予了抗血小板药物，但该结构随时间而增大。除血栓外，还考虑到壁内血肿和肿瘤性病变的鉴别诊断。发病后第 6 天行颈动脉内膜切除术。病理检查发现混合血栓附着于 CaW；然而，未观察到肿瘤性变化。无术后并发症，患者在第 14 天无神经功能缺损出院。CaW 在形态上具有与血栓形成高风险相关的解剖学因素。从病理上考虑，水动力因素的影响比 CaW 表面形态的影响更为显著。CUS 是评估血栓形态的有用工具。
