Takahashi Toshihide, Yanaka Kiyoyuki, Saura Minami, Aiyama Hitoshi, Takahashi Nobuyuki, Marushima Aiki, Matsumaru Yuji, Ishikawa Eiichi
Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan.
Department of Radiology, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan.
J Neurosurg Case Lessons. 2025 Jan 20;9(3). doi: 10.3171/CASE24682.
Carotid webs are rare nonatherosclerotic disorders in the carotid artery and are increasingly recognized as factors of ischemic stroke in the young population. Asymptomatic webs can be treated with antithrombotic therapy, whereas symptomatic cases frequently require surgical interventions, including carotid endarterectomy (CEA). However, guidelines for the optimal timing of these treatments remain unestablished, especially compared to atherosclerotic stenotic lesions, due to the rarity of carotid webs.
A 50-year-old female patient had a carotid web-induced left hemispheric ischemic stroke. Mechanical thrombectomy successfully restored blood flow, but a thrombus reformed in the carotid web within 1 month following the procedure. This caused early CEA, during which the carotid web and thrombus were removed. This case highlights rapid thrombus reformation, indicating that some carotid webs can be more unstable than previously thought.
This case emphasizes the importance of timely surgical intervention in symptomatic carotid webs to prevent recurrent strokes. Additionally, antithrombotic therapy can manage asymptomatic webs, but surgical treatment may be required in unstable cases. Thus, further studies are warranted to establish standardized treatment guidelines for carotid webs. https://thejns.org/doi/10.3171/CASE24682.
颈动脉纤维网是颈动脉罕见的非动脉粥样硬化性疾病，越来越被认为是年轻人群缺血性卒中的病因。无症状的纤维网可采用抗血栓治疗，而有症状的病例通常需要手术干预，包括颈动脉内膜切除术（CEA）。然而，由于颈动脉纤维网罕见，与动脉粥样硬化性狭窄病变相比，这些治疗的最佳时机指南仍未确立。
一名50岁女性患者发生了由颈动脉纤维网引起的左半球缺血性卒中。机械取栓成功恢复了血流，但术后1个月内颈动脉纤维网内血栓再次形成。这导致了早期CEA，术中切除了颈动脉纤维网和血栓。该病例突出了血栓的快速再形成，表明一些颈动脉纤维网可能比之前认为的更不稳定。
该病例强调了对有症状的颈动脉纤维网及时进行手术干预以预防复发性卒中的重要性。此外，抗血栓治疗可用于处理无症状的纤维网，但不稳定的病例可能需要手术治疗。因此，有必要进行进一步研究以建立颈动脉纤维网的标准化治疗指南。https://thejns.org/doi/10.3171/CASE24682 。
