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Rodríguez-Castro E, Arias-Rivas S, Santamaría-Cadavid M, López-Dequidt I, Rodríguez-Yáñez M, Mosqueira AJ, Blanco Ulla M, Vázquez Herrero F, Castiñeira JA, Martínez-Sáez E, Pérez Béliz E, Mosquera N, Caicedo D, Fraga M, Pumar JM. Carotid web: the challenging diagnosis of an under-recognized entity. J Neurol 2022; 269:5629-5637. [PMID: 35713691 DOI: 10.1007/s00415-022-11210-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Determining the cause of acute ischemic stroke is crucial for patient management, particularly for preventing future stroke. In recent years, carotid web (CW), a non-atherosclerotic disorder of the carotid wall, has been found to be an underestimated source of cerebral emboli. OBJECTIVE The present study aimed to analyze the clinical, radiological, and pathological findings, along with the treatments performed in patients with CW and ipsilateral ischemic events. METHODS Patients with anterior circulation ischemic stroke or transient ischemic attack and ipsilateral CW were prospectively included from January 2019 to December 2021. RESULTS Nine patients were enrolled. The median age was 55 (43-62) years, with a female-to-male ratio of 3.5:1. Of the total, seven patients (78%) consulted for recurrent ipsilateral ischemic events. Despite medical treatment, 44% of the patients experienced new episodes. Computed tomographic angiography was suggestive of CW in all cases in which it was performed. The interval between the first ischemic event and diagnosis of CW was of 13 (6-68) months. After ruling out any other possible etiology, every patient underwent carotid revascularization, one underwent stenting and eight underwent carotidectomy. No severe or long-term complications were noted. Histological studies confirmed the diagnosis of CW. There were no recurrences after carotid revascularization during a follow-up of 24 (13-35) months. CONCLUSION Knowledge of CW and differentiating it from atheroma plaques is essential, as medical management seems to be insufficient in many cases. Revascularization, which has been shown to be safe and effective, might be the best treatment modality.
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Affiliation(s)
- Emilio Rodríguez-Castro
- Stroke Unit, Department of Neurology, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa Travesa da Choupana, s/n, 15706, Santiago de Compostela, Spain.
| | - Susana Arias-Rivas
- Stroke Unit, Department of Neurology, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa Travesa da Choupana, s/n, 15706, Santiago de Compostela, Spain
| | - María Santamaría-Cadavid
- Stroke Unit, Department of Neurology, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa Travesa da Choupana, s/n, 15706, Santiago de Compostela, Spain
| | - Iria López-Dequidt
- Stroke Unit, Department of Neurology, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa Travesa da Choupana, s/n, 15706, Santiago de Compostela, Spain
| | - Manuel Rodríguez-Yáñez
- Stroke Unit, Department of Neurology, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa Travesa da Choupana, s/n, 15706, Santiago de Compostela, Spain
| | - Antonio Jesús Mosqueira
- Department of Neuroradiology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Miguel Blanco Ulla
- Department of Neuroradiology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Fernando Vázquez Herrero
- Department of Neuroradiology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - José Antonio Castiñeira
- Department of Neuroradiology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Elena Martínez-Sáez
- Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Edurne Pérez Béliz
- Department of Pathology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Nilo Mosquera
- Department of Angiology and Vascular Surgery, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Diego Caicedo
- Department of Angiology and Vascular Surgery, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Máximo Fraga
- Department of Pathology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Department of Forensic Sciences, Pathology, Gynecology and Obstetrics, and Pediatrics, Faculty of Medicine of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Manuel Pumar
- Department of Neuroradiology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,President of Sociedad Íbero Latino Americana de Neurorradiología Diagnóstica y Terapéutica (SILAN), Barcelona, Spain.,Chair of Interventional Neuroradiology of the University of Santiago de Compostela (CINIUS), Santiago de Compostela, Spain
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