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Wang LZ, Calvet D, Julia P, Domigo V, Mohamedi N, Alsac JM, El Batti S, Messas E, Mirault T, Bruneval P, Goudot G. Is carotid web an arterial wall dysplasia? A histological series. Cardiovasc Pathol 2023; 66:107544. [PMID: 37263518 DOI: 10.1016/j.carpath.2023.107544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Described for 60 years under various names, the carotid web is a suspected cause of cryptogenic stroke, especially in young patients. The web creates an intraluminal protrusion that may contribute to turbulent flow and thrombus embolization into cerebral arteries. Although the carotid web has frequently been related to arterial fibrodysplasia, its natural history and pathological description remain unclear. PATIENTS Among all consecutive patients admitted to the stroke unit of Sainte-Anne Hospital and referred to the vascular surgery department from January 2015 to December 2022, we retrospectively identified 9 patients with a carotid web. The surgical specimens of the 9 patients were submitted to systematic pathological analysis. RESULTS The patients with a histologically confirmed carotid web were young (median age was 42 years), prominently women (7/9), and presenting with low cardiovascular risk. Eight patients had a stroke proven by a magnetic resonance imaging, and 1 had transient monocular amaurosis. The typical pathological lesion supporting the imaging pattern of the carotid web was a focal eccentric intimal hyperplasia forming a protruding lesion characterized by a population of vascular smooth muscle cells intermingled in an abundant, most often loose extracellular matrix. Pathologically proven thrombus was observed in 4 cases. Importantly atherosclerosis was absent. CONCLUSION Histological features in our 9 cases strengthen carotid web characterization as a homogeneous pattern of localized intimal hyperplasia. It is a unique entity consistent with intimal fibroplasia, distinct from medial fibromuscular dysplasia and early atherosclerosis.
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Affiliation(s)
- Louise Z Wang
- Vascular medicine department, Georges Pompidou European hospital, APHP, Paris University Paris France; INSERM U970 PARCC, Université Paris Cité, Paris, France
| | - David Calvet
- Department of Neurology and Stroke Unit, Sainte-Anne hospital, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM 1266, Institut de Psychiatrie et Neurosciences de Paris, FHU Neurovasc -Paris, France
| | - Pierre Julia
- Vascular surgery department, Georges Pompidou European hospital, APHP, Université Paris Cité, Paris, France
| | - Valérie Domigo
- Department of Neurology and Stroke Unit, Sainte-Anne hospital, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM 1266, Institut de Psychiatrie et Neurosciences de Paris, FHU Neurovasc -Paris, France
| | - Nassim Mohamedi
- Vascular medicine department, Georges Pompidou European hospital, APHP, Paris University Paris France
| | - Jean-Marc Alsac
- Vascular surgery department, Georges Pompidou European hospital, APHP, Université Paris Cité, Paris, France
| | - Salma El Batti
- Vascular surgery department, Georges Pompidou European hospital, APHP, Université Paris Cité, Paris, France
| | - Emmanuel Messas
- Vascular medicine department, Georges Pompidou European hospital, APHP, Paris University Paris France; INSERM U970 PARCC, Université Paris Cité, Paris, France
| | - Tristan Mirault
- Vascular medicine department, Georges Pompidou European hospital, APHP, Paris University Paris France; INSERM U970 PARCC, Université Paris Cité, Paris, France
| | - Patrick Bruneval
- Cardiology department, Georges Pompidou European hospital, APHP, Université Paris Cité, Paris France
| | - Guillaume Goudot
- Vascular medicine department, Georges Pompidou European hospital, APHP, Paris University Paris France; INSERM U970 PARCC, Université Paris Cité, Paris, France.
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