Neurological Surgery No Shinkei Geka Volume 47, Issue 6 (June 2019)

Reconsideration of Carotid Web and the Therapeutic Strategy Ichiro KAWAHARA 1 , Takeshi HIU 1 , Tomonori ONO 1 , Wataru HARAGUCHI 1 , Ryujiro USHIJIMA 1 , Keisuke TSUTSUMI 1 1Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center Keyword: carotid endarterectomy , carotid web , three dimensional CT angiography pp.659-666
Published Date 2019/6/10
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 The term “carotid web” was first used in 1973 and is considered a rare form of fibromuscular dysplasia(FMD). A carotid web was reported to produce thrombus formation and cause of ischemic events. However, it is rarely reported because of its low incidence. As for the diagnosis, noninvasive routine radiological modalities such as ultrasonography or magnetic resonance angiography may have very low sensitivity due to the subtle nature of the entity. Therefore, these types of lesions may be often underdiagnosed.

 We describe three cases that presented with minor and recurrent major ischemic strokes resistant to medical management. All 3 cases had a good course with no recurrence after carotid endarterectomy. On pathological examination, all specimens revealed mild atherosclerotic change, although FMD was known to be a non-inflammatory and non-atherosclerotic angiopathy.

 Early detection of a carotid web is highly important. Three-dimensional CT angiography(3D-CTA)maximum intensity projection(MIP)imaging seems to be a reliable noninvasive technique, although catheter angiography is considered as the gold standard.

 The cases with carotid web have characteristics such as more recurrent ischemic stroke and resistance to medical management. Surgical treatment should be considered if medical management in unsuccessful. Moreover, even if asymptomatic, it might also be considered for cases with a growing web or with blood stasis behind the web.

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Neurological Surgery 脳神経外科
47巻6号 (2019年6月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院