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Fibromuscular Dysplasia at the Internal Carotid Origin: A case of carotid web Shu WATANABE 1 , Keisei TANAKA 1 , Teiji NAKAYAMA 1 , Mitsuo KANEKO 1 1Department of Neurosurgery, Hamamatsu Medical Center Keyword: Fibromuscular dysplasia , Web shape , Transient ischemic attack pp.449-452
Published Date 1993/5/10
DOI https://doi.org/10.11477/mf.1436900648
  • Abstract
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A case of fibromuscular dysplasia at the internal carotid origin is reported.

A 45-year-old, right-handed woman who was in good health, experienced 5 - 6 second episodes of numbness and tingling in her right hand and lip. She had no history of medical illness or trauma.

The patient suffered the same sort of attack almost seven years after her first episode.

General examination was unremarkable. There was no sign of residual neurologic deficit. Cerebral angiography demonstrated a discrete filling defect at the internal caro-tid coign. There was no evidence of atherosclerosis in the intracranial or extracranial vessels. The lesion occluded approximately 58% of the lumen. A carotid endar-terectomy was performed and a web shaped' tissue was removed from the posterior aspect of the right inter-nal carotid artery. Microscopic examination of the sur-gical specimen demonstrated intimal fibrosis, consistent with the diagnosis of fibromuscular dysplasia. In addition to our patient, eight other cases of cephalic fibromuscular dysplasia have been reported in the form of an internal carotid web. This type of lesion is unique because the changes involve only the intima of the ves-sels without involvement of the medial structure as is seen in the usual form of fibromuscular dysplasia. Moreover, 5 out of 9 patients reported had the repeated episodes of the ischemic symptom, suggesting patients with this particular lesion have higher risk for stroke than those with the usual “string of beads” lesion. In these pa-tients, surgical treatment should be considered, especial-ly if medical therapy is unsuccessful.


Copyright © 1993, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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