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NEUROIMAGE
Year : 2022  |  Volume : 70  |  Issue : 2  |  Page : 826-827

Carotid Web Coexisting with Vertebral Web in a Middle-Aged Woman


Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China

Date of Submission09-Mar-2020
Date of Decision09-Jul-2020
Date of Acceptance05-Aug-2020
Date of Web Publication3-May-2022

Correspondence Address:
Dr. Wenjie Cao
Department of Neurology, Huashan Hospital, Fudan University, 12 middle Wulumuqi Road, Shanghai – 200 040
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.344632

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How to cite this article:
Wang Z, Mao Y, Zhao H, Ling Y, Cheng X, Cao W. Carotid Web Coexisting with Vertebral Web in a Middle-Aged Woman. Neurol India 2022;70:826-7

How to cite this URL:
Wang Z, Mao Y, Zhao H, Ling Y, Cheng X, Cao W. Carotid Web Coexisting with Vertebral Web in a Middle-Aged Woman. Neurol India [serial online] 2022 [cited 2022 May 22];70:826-7. Available from: https://www.neurologyindia.com/text.asp?2022/70/2/826/344632




A previously healthy 53-year-old female presented with sudden onset of aphasia and right-sided hemiparesis. Brain diffusion-weighted magnetic resonance imaging (MRI) disclosed acute infarctions involving the left middle cerebral artery territories [Figure 1]a. Cervical CT angiography showed a septum in the left internal carotid artery (ICA) [Figure 1]b. Cervical vessel wall MRI demonstrated a ridge-like protrusion originating from the posterior wall of the left ICA [Figure 1]c. Digital subtraction angiography (DSA) revealed filling deficits in the left ICA and the ostium of the left vertebral artery [Figure 1]d, [Figure 1]e, suggesting the diagnosis of carotid and vertebral webs. The patient underwent carotid endarterectomy. Histopathology showed extensive intimal fibromuscular proliferation with fibrosis and myxoid degeneration [Figure 1]f, confirming the diagnosis of carotid web.
Figure 1: (a) Acute infarctions on diffusion-weighted imaging in the left MCA territories. (b) Neck CTA showed a septum in the left ICA. (c) Vessel wall MRI demonstrated a protrusion originating from the posterior wall of the left ICA. (d) DSA revealed membrane-like septa in the left ICA. (e) The left vertebral artery. (f) Histopathology demonstrated extensive fibromuscular proliferation (arrow) and myxoid degeneration (arrowhead) (Hematoxylin-eosin staining)

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First reported in 1968, carotid web is pathologically characterized by significant intimal fibroplasia, consistent with the intimal type of fibromuscular dysplasia.[1] A 21.2% prevalence of carotid web has been reported in the cryptogenic stroke population.[2] Whereas, carotid web coexisting with vertebral web in an individual have rarely been reported. Vessel wall MRI can not only show the intraluminal web, but also demonstrate the thickening and increased signal of the vessel wall on the side of the web.[3] DSA remains the gold standard imaging method to demonstrate not only the shelf-like protrusion but also the blood stagnation. The turbulent blood flow and stagnation distal to the web result in thrombus formation and subsequent embolism.[4] Carotid web-related strokes have high risk of recurrence. It is carotid revascularization rather than medications that have been shown to sufficiently prevent the recurrent events in symptomatic carotid web patients.[3] We emphasize that carotid web is an important cause of cryptogenic strokes.

Acknowledgments

The authors thank Dr. Yuxiang Gu, Hong Chen and Haixia Cheng for pathologic analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rainer WG, Cramer GG, Newby JP, Clarke JP. Fibromuscular hyperplasia of the carotid artery causing positional cerebral ischemia. Ann Surg 1968;167:444-6.  Back to cited text no. 1
    
2.
Sajedi PI, Gonzalez JN, Cronin CA, Kouo T, Steven A, Zhuo J, et al. Carotid bulb webs as a cause of “cryptogenic” ischemic stroke. AJNR Am J Neuroradiol 2017;38:1399-404.  Back to cited text no. 2
    
3.
Kim SJ, Nogueira RG, Haussen DC. Current understanding and gaps in research of carotid webs in ischemic strokes: A review. JAMA Neurol 2018;76:355-61.  Back to cited text no. 3
    
4.
Choi PM, Singh D, Trivedi A, Qazi E, George D, Wong J, et al. Carotid webs and recurrent ischemic strokes in the era of CT angiography. AJNR Am J Neuroradiol 2015;36:2134-9.  Back to cited text no. 4
    


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