ISCHEMIC STROKE

Carotid artery web

Created 02.04.2021, last update 12.01.2022

Definition

  • the carotid artery web is increasingly recognized as an important cause of (recurrent) ischemic stroke in patients without other cardiovascular risk factors
  • it is a thin membrane extending from the posterior wall of the carotid artery bulb into the lumen just above the bifurcation and is considered a variant of fibromuscular dysplasia  [Kim, 2019]
  • various synonyms are used: carotid weblike formation, carotid pseudovalvular fold, carotid diaphragm
  • a relatively rare vascular pathology with thrombogenic potential (due to blood stasis along the downstream surface of the web) which can lead to intracranial thromboembolism  [Compagne, 2019]
    • a significant risk factor in cryptogenic and recurrent ischemic stroke (the incidence rate of carotid web in cryptogenic stroke is 8.9% vs. 1.9% in the control group)   [Coutinho, 2017]
Carotid artery web

Epidemiology

Clinical presentation

  • often an asymptomatic, accidental lesion
  • thrombus formation can lead to a recurrent stroke/TIA
    • recurrence present in up to 29% of patients despite medical treatment [Haussen, 2019]
    • the web is a significant cause of “cryptogenic stroke” in young patients

Diagnostic evaluation

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Differential diagnosis

  • dissection
    • usually longer and localized distally (typically bellow skull base)
    • irregular margins, sometimes a double lumen is seen
  • atherosclerotic plaque
    • different shape, irregular margins
    • calcifications are often present
Differential diagnosis of carotid artery web

Management

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