| 제목 |
A Case of a Carotid Web in Cerebral Infarction |
| 소속 |
Kyung Hee University Medical Center, Department of Rehabilitation Medicine1 |
| 저자 |
Jinmann Chon1†, Hee-Sang Kim1, Jong Ha Lee 1, Dong Hwan Yun1, Yunsoo Soh1, Yong Kim1, Myung Chul Yoo1, Seong Min Choi 1* |
A Carotid web is a rare form of focal intimal fibromuscular dysplasia, which is a shelf-like filling defect in the posterior aspect of the internal carotid artery bulb. It is recognized as a potential source for cryptogenic ischemic strokes in young patients. We report a case in which a left carotid web was diagnosed as a cause of acute ischemic stroke in a 45-year-old female patient without other risk factors for stroke.
A 45-year-old female presented to a emergency room with an altered mental state. The patient had right side weakness, facial palsy and aphasia at the time of admission. Computed tomography angiography (CTA) showed complete occlusion of left M1 segment and focal moderate stenosis of left proximal internal carotid artery. Brain MRI revealed acute ischemic stroke in the distribution of left middle cerebral artery. Thrombectomy was performed and left proximal M1 segment was completely recanalized. Doppler ultrasonography was performed and it showed heterogenous, echogenic mass at the left ICA bifurcation causing 35% stenosis and turbulent blood flow behind the mass (Figure 1). Transfemoral cerebral angiography revealed shelf-like projection arising from the posterior wall of the left internal carotid artery bulb (Figure 2). Theses findings suggested the diagnosis of a carotid web. The patient was planned to treat with aspirin 100 mg, cilostazol 50 mg, lipitor 40 mg. Transthoracic echocardiogram with saline study was performed and showed no significant right to left shunt. Laboratory findings for hypercoagulability and vasculitis were unremarkable. Extremity arterial and venous doppler was unremarkable. The patient’s symptoms improved over time and after one month, she could gait under supervision and her muscle strength showed improvement from poor to fair on manual muscle testing grading scale.
We report a patient diagnosed with a carotid web using transfemoral cerebral angiography. A carotid web is a rare cause of ischemic stroke, its prevalence is not known. A proposed pathophysiology is a carotid web may cause turbulent blood flow and stasis distal to the lesion, resulting in thrombus formation over the web and systemic embolism. |
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Fig 1. Carotid artery doppler sonography showed carotid web at the left ICA bifurcation and turbulent blood flow distal to a carotid web.
Fig 2. Angiography of the common carotid artery revealed the carotid web. (Arrow)
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