Rivoire Emeraude, Della Schiava Nellie, Rouvière Olivier, Pagnoux Gaele, Cho Tae-Hee, Millon Antoine, Long Anne
Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France.
Université Claude Bernard Lyon 1, Laboratoire Inter Universitaire de la Biologie et de la Motricité, UR7424, Equipe Athérosclérose Thrombose et Activité Physique, Lyon, France.
Vasc Med. 2025 Feb;30(1):82-92. doi: 10.1177/1358863X241282635. Epub 2024 Oct 13.
A carotid web (CaWeb), otherwise known as a carotid bulb diaphragm, is a spur of intimal fibrous tissue extending into the carotid bulb. It is a rare, underdiagnosed cause of ischemic strokes in young people. The purpose of this narrative review was to provide an update on CaWebs, highlighting recent evolutions in their management. We undertook a comprehensive literature search on main electronic databases - MEDLINE/PubMed, Cochrane Library, Web of Science, and EMBASE - using a dedicated equation to include studies up to February 13, 2024. We also searched for the most recent guidelines about carotid disease or stroke including CaWeb management. A CaWeb is found in up to 10% of young patients, particularly young women, with severe anterior stroke due to an arterial-arterial embolism from the intra-nidus thrombus. Most patients with a CaWeb have less than 50% stenosis on duplex ultrasound, and diagnosis is mostly obtained by computed tomography angiography. When applying traditional stenosis criteria for symptomatic disease (> 50% stenosis), this highly morbid condition is easily overlooked, leading to recurrent strokes. Antithrombotic treatment is associated with a high recurrence rate of stroke after the index event. The first-line treatment of symptomatic CaWebs is increasingly based on endarterectomy or stenting. The lack of recommendations before 2021 and recent discordant guidelines make CaWeb management complex. No guidelines are available to manage patients with asymptomatic CaWebs. Results from ongoing multicenter registries will be useful in guiding management decisions.
颈动脉膜（CaWeb），又称颈动脉球隔膜，是一种延伸至颈动脉球的内膜纤维组织嵴。它是年轻人缺血性卒中的一种罕见且诊断不足的病因。本叙述性综述的目的是提供关于颈动脉膜的最新信息，突出其治疗方面的最新进展。我们使用专门的检索式在主要电子数据库——MEDLINE/PubMed、Cochrane图书馆、科学网和EMBASE——上进行了全面的文献检索，纳入截至2024年2月13日的研究。我们还搜索了关于颈动脉疾病或卒中（包括颈动脉膜治疗）的最新指南。在高达10%的因巢内血栓导致动脉-动脉栓塞而发生严重前循环卒中的年轻患者中可发现颈动脉膜，尤其是年轻女性。大多数患有颈动脉膜的患者在双功超声检查中狭窄程度小于50%，诊断大多通过计算机断层血管造影获得。当应用有症状疾病的传统狭窄标准（狭窄>50%）时，这种高致残性疾病很容易被忽视，导致复发性卒中。抗栓治疗与首次事件后卒中的高复发率相关。有症状颈动脉膜的一线治疗越来越多地基于内膜切除术或支架置入术。2021年之前缺乏相关推荐以及近期指南存在分歧使得颈动脉膜的治疗变得复杂。目前尚无管理无症状颈动脉膜患者的指南。正在进行的多中心注册研究结果将有助于指导治疗决策。
