Burke Daniel L, Malkoc Aldin, Andacheh Iden
Division of Vascular Surgery, Department of Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA 92335, USA.
Division of Vascular Surgery, Department of Surgery, Arrowhead Regional Medical Center, Colton, CA 92324, USA.
J Med Cases. 2025 Feb;16(2):82-86. doi: 10.14740/jmc4339. Epub 2025 Feb 2.
Internal carotid artery webs (ICAWs) have been described as noninflammatory, nonatherosclerotic shelf-like projections of intimal fibrous tissue which may be the culprit for embolic stroke of unknown origin. Carotid webs are an atypical form of intimal fibromuscular dysplasia (FMD) and internal carotid webs create areas of stagnation and recirculation distal to the web that favor thrombus formation and embolism. Symptomatic carotid webs are conventionally associated with young women presenting with few vascular risk factors and < 50% stenosis in the affected ICA. ICAWs are being described more and more in the vascular literature, but the management of this pathology remains unclear. We describe a rare case of a 90-year-old male who presented with a significantly sclerosed symptomatic right ICAW without evidence of comorbid atherosclerotic disease. The clinical management, intraoperative findings, and postoperative course are described herein. At the age of 90, this patient is the oldest case of symptomatic carotid web recorded in the literature. Successful management with a carotid endarterectomy is an appropriate strategy for treatment even in a nonagenarian. We would favor carotid endarterectomy over carotid artery stenting given the circumferential, fibrotic nature of these lesions.
颈内动脉网（ICAWs）被描述为内膜纤维组织的非炎性、非动脉粥样硬化的 shelf 样突起，可能是不明原因栓塞性卒中的罪魁祸首。颈动脉网是内膜纤维肌发育不良（FMD）的一种非典型形式，颈内动脉网在网的远端形成血流停滞和再循环区域，有利于血栓形成和栓塞。有症状的颈动脉网通常与血管危险因素少且患侧颈内动脉狭窄<50%的年轻女性相关。ICAWs 在血管文献中被越来越多地描述，但这种病理状况的治疗仍不明确。我们描述了一例罕见的 90 岁男性病例，其右侧有症状的颈内动脉网明显硬化，无合并动脉粥样硬化疾病的证据。本文描述了其临床治疗、术中发现及术后病程。90 岁的该患者是文献记载中年龄最大的有症状颈动脉网病例。即使对于九旬老人，颈动脉内膜切除术的成功治疗也是一种合适的策略。鉴于这些病变的周向、纤维化性质，我们更倾向于颈动脉内膜切除术而非颈动脉支架置入术。
