Konieczna-Brazis Magdalena, Brazis Pawel, Switonska Milena, Migdalski Arkadiusz
Department of Neurology and Clinical Neurophysiology, Jan Biziel University Hospital No. 2, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland, Ujejskiego Street 75, 85-168 Bydgoszcz, Poland.
Department of Vascular Surgery and Angiology, University Hospital No. 1, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland, M. Sklodowskiej-Curie Street 9, 85-094 Bydgoszcz, Poland.
J Clin Med. 2025 Apr 9;14(8):2568. doi: 10.3390/jcm14082568.
: Carotid web (CaW) usually presents as a shelf-like intimal flap at the beginning of the internal carotid artery. It has been proven that CaW is associated with ischemic stroke, particularly in young patients without other risk factors. This case report aimed to describe the carotid web that causes ischemic stroke due to embolic complications. Moreover, both pathologies were successfully treated with endovascular techniques in the presented case study. : A 59-year-old male presented to the neurological department with motor aphasia, right-sided weakness, and hypoesthesia. Computer tomography (CT) of the head and computed tomography angiography (CTA) of the aortic arch and intracranial arteries were performed. Due to the unknown onset of the presented stroke symptoms, diagnostics were extended to magnetic resonance (MR), and based on this, the patient qualified for immediate mechanical thrombectomy (according to the DAWN trial protocol). Intraoperative digital subtraction angiography (DSA) revealed embolism material in the left middle cerebral artery (segment M1). The artery was recanalized via aspiration thrombectomy using the Penumbra system, and complete restoration of flow was obtained (according to the TICI scale). In addition, DSA revealed the presence of CaW changes in the left internal carotid artery (LICA). In the control CT scanning, an acute ischemic area in the left temporal lobe was found. After the treatment, the patient demonstrated complete neurological improvement from his initial presentation. He qualified for carotid artery stenting of the LICA, which was postponed to a later period due to the presence of an area of infarction. The angioplasty with stenting was performed 6 months later, and a carotid antiembolic "mesh" stent (Roadsaver, Terumo) was implanted into the LICA across the carotid web. : CaW should be considered in the case of stroke resulting from unknown causes. The presented case study demonstrated that both carotid web and ischemic stroke pathologies can be effectively treated with emerging endovascular techniques.
颈动脉蹼（CaW）通常表现为颈内动脉起始处的 shelf 样内膜瓣。已证实 CaW 与缺血性卒中相关，尤其是在无其他危险因素的年轻患者中。本病例报告旨在描述因栓塞并发症导致缺血性卒中的颈动脉蹼。此外，在本病例研究中，两种病症均通过血管内技术成功治疗。：一名 59 岁男性因运动性失语、右侧肢体无力和感觉减退就诊于神经科。进行了头部计算机断层扫描（CT）以及主动脉弓和颅内动脉的计算机断层血管造影（CTA）。由于所呈现的卒中症状发病时间不明，诊断扩展至磁共振成像（MR），基于此，患者符合立即进行机械取栓术的标准（根据 DAWN 试验方案）。术中数字减影血管造影（DSA）显示左大脑中动脉（M1 段）有栓塞物质。使用 Penumbra 系统通过抽吸血栓切除术使该动脉再通，并实现了血流的完全恢复（根据 TICI 分级）。此外，DSA 显示左颈内动脉（LICA）存在 CaW 改变。在对照 CT 扫描中，发现左颞叶有急性缺血区。治疗后，患者的神经系统症状从最初表现完全改善。他符合 LICA 颈动脉支架置入术的标准，但由于存在梗死区域而推迟至后期。6 个月后进行了血管成形术并置入支架，将一个颈动脉抗栓“网状”支架（Roadsaver，泰尔茂）穿过颈动脉蹼植入 LICA。：对于病因不明的卒中病例，应考虑颈动脉蹼。本病例研究表明，新兴的血管内技术可有效治疗颈动脉蹼和缺血性卒中这两种病症。
