Carotid Web Phenotype Is Uncommonly Associated With Classic Fibromuscular Dysplasia: A Retrospective Observational Study

Stroke ◽  
2021 ◽  
Author(s):  
Vera Sharashidze ◽  
Raul G. Nogueira ◽  
Alhamza R. Al-Bayati ◽  
Nirav Bhatt ◽  
Fadi B Nahab ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Fibromuscular Dysplasia ◽  
Internal Carotid ◽  
Filling Defect ◽  
High Yield ◽  
Conventional Angiography ◽  
Posterior Aspect ◽  
Carotid Bulb ◽  
Ischemic Attack

Background and Purpose: Carotid web (CaW) is an intimal form of fibromuscular dysplasia (FMD) involving the carotid bulb which has been increasingly recognized as a potential cause of recurrent ischemic strokes. It is overlooked as a separate entity and often dismissed if no coexistent signs of classic FMD changes are observed. We aim to evaluate the frequency of classic FMD in high-yield vascular territories in patients with symptomatic CaW. Methods: This was a retrospective analysis of a symptomatic CaW database of 2 comprehensive stroke centers (spanning September 2014–October 2020). The diagnosis of a CaW during a stroke workup was defined as the presence of a shelf-like linear filling defect in the posterior aspect of the carotid bulb on computed tomography angiography in patients with acute ischemic stroke or transient ischemic attack of undetermined cause after a thorough evaluation. Neck computed tomography angiography and renal conventional angiography images were independently evaluated by two readers blinded to the laterality and clinical details to inspect the presence of underlying classic FMD. Results: Sixty-six patients with CaW were identified. Median age was 51 years (interquartile range, 42–57), and 74% were women. All patients had neck computed tomography angiography (allowing for bilateral vertebral and carotid evaluation), whereas 47 patients had additional digital subtraction angiography (which evaluated 47 carotids ipsilateral to the stroke and 10 contralateral carotids). Internal carotid artery classic FMD changes were noted in only 6 out of 66 (9%) in the ipsilateral carotids. No contralateral carotid or vertebral artery classic FMD changes were observed. Renal artery catheter-based angiography was obtained in 16 patients/32 arteries and only 1 patient/2 renal arteries demonstrated classic FMD changes. Conclusions: CaW phenotype is uncommonly associated with classic FMD changes. Coexistent classic FMD does not constitute a useful marker to corroborate or exclude CaW diagnosis.

scholarly journals Multicenter Experience with Stenting for Symptomatic Carotid Web

2018 ◽  
Vol 7 (6) ◽  
pp. 413-418 ◽  
Author(s):  
Diogo C. Haussen ◽  
Jonathan A. Grossberg ◽  
Sebastian Koch ◽  
Amer Malik ◽  
Dileep Yavagal ◽  
...  
Keyword(s):  
Surgical Excision ◽  
Carotid Stenting ◽  
Functional Independence ◽  
Filling Defect ◽  
Conventional Angiography ◽  
Posterior Aspect ◽  
Symptomatic Carotid ◽  
Carotid Bulb ◽  
Ischemic Attack

Background: A carotid web (CaW) is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. CaW has been associated with recurrent strokes and conventionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic CaWs. Methods: Retrospective review of consecutive patients admitted to 5 comprehensive stroke centers who were identified to have a symptomatic CaW and treated with carotid stenting. A symptomatic CaW was defined by the presence of a shelf-like/linear, smooth filling defect in the posterior aspect of the carotid bulb diagnosed by neck CT angiography (CTA) and confirmed with conventional angiography in patients with negative stroke workup. Results: Twenty-four patients with stented symptomatic CaW were identified (stroke in 83% and transient ischemic attack in 17%). Their median age was 47 years (IQR 41–61), 14 (58%) were female, and were 17 (71%) black. The degree of stenosis by NASCET was 0% (range 0–11). All patients were placed on dual antiplatelets and stented at a median of 9 days (IQR 4–35) after the last event. Closed-cell stents were used in 18 (75%) of the cases. No periprocedural events occurred with the exception of 2 cases of asymptomatic hypotension/bradycardia. Clinical follow-up after stent placement occurred for a median of 12 months (IQR 3–19) with no new cerebrovascular events noted. Functional independence at 90 days was achieved in 22 (91%) patients. Follow-up vascular imaging (ultrasound n = 18/CTA n = 5) was performed at a median of 10 months (IQR 3–18) and revealed no stenosis. Conclusions: Stenting for symptomatic CaW appears to be a safe and effective alternative to surgical resection. Further studies are warranted.

Intravascular Ultrasound in Carotid Web

2019 ◽  
Vol 12 (5) ◽  
pp. 531-534 ◽  
Author(s):  
Sara Hassani ◽  
Raul G Nogueira ◽  
Alhamza R Al-Bayati ◽  
Rajesh Sachdeva ◽  
Michael McDaniel ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Fibromuscular Dysplasia ◽  
Case Series ◽  
Filling Defect ◽  
Vessel Occlusion ◽  
Posterior Aspect ◽  
Guide Catheter ◽  
Carotid Bulb ◽  
The Common ◽  
Clear Differentiation

BackgroundCarotid web (CaW) is a shelf-like linear filling defect in the posterior aspect of the internal carotid bulb, representing an intimal variant of fibromuscular dysplasia. The diagnosis of CaW is traditionally restricted to digital subtraction angiography (DSA), CT/MR angiography (CTA/MRA), and Duplex ultrasonography. In this series of patients with acute ischemic stroke, we evaluated the potential utility of intravascular ultrasound (IVUS) in further characterizing suspected CaWs.MethodsThis is a case series of three patients with suspected CaW who underwent DSA for treatment or investigation of large vessel occlusion strokes. In all cases the stroke investigation failed to identify an alternative cause, and the stroke etiology was attributed to a symptomatic CaW. The procedure consisted of positioning a guide catheter in the common carotid artery, navigating the IVUS probe distal to the carotid bulb, and then retracting the probe with a manual pullback. The acquired images were then reviewed in an independent workstationResultsIn two of the three cases, IVUS showed an isoechoic-to-hyperechoic focal eccentric area at the posterior carotid bulb, consistent with CaW. The endoluminal protrusion was inconspicuous on IVUS due to the low resolution of ultrasound not allowing a clear differentiation between fibrosis, thrombosis, and atherosclerosis. No abnormalities commonly associated with atherosclerotic disease or dissections were noted. The CaW could not be depicted in the third patient.ConclusionThe use of IVUS in the diagnosis of CaW may have limited relevance. Continued investigation of other imaging modalities for accurate CaW diagnosis is recommended.

scholarly journals Evaluation of preoperative computed tomography angiography in association with conventional angiography versus computed tomography angiography only, in the endovascular treatment of aortic diseases

2013 ◽  
Vol 46 (5) ◽  
pp. 265-272 ◽  
Author(s):  
Patrick Bastos Metzger ◽  
Eduardo Rafael Novero ◽  
Fabio Henrique Rossi ◽  
Samuel Martins Moreira ◽  
Frederico Augusto Linhares ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Endovascular Treatment ◽  
Computed Tomography Angiography ◽  
Therapeutic Intervention ◽  
Technical Success ◽  
Aortic Diseases ◽  
Conventional Angiography ◽  
Therapeutic Success ◽  
Abdominal Aortic

Objective To evaluate the association of conventional angiography (AG) with computed tomography angiography (CTA) as compared with CTA only, preoperatively, in the treatment of aortic diseases. Materials and Methods Retrospective study involving patients submitted to endovascular treatment of aortic diseases, in the period from January 2009 to July 2010, with use of preoperative CTA + conventional AG or CTA only. The patients were divided into two groups, namely: G1 – thoracic aortic diseases; and G2 – abdominal aortic diseases. G1 was subdivided into 1A (preoperative AG + CTA) and 1B (preoperative CTA). G2 was subdivided into 2C (CTA + AG) and 2D (CTA only). Results The authors evaluated 156 patients. In subgroups 1A and 1B, the rate of technical success was, respectively, 100% and 94.7% (p = 1.0); and the rate of therapeutic success was, respectively, 81% and 58% (p = 0.13). A higher number of complications were observed in subgroup 1B (p = 0.057). The accuracy in the calculation of the prosthesis was higher in subgroup 1A (p = 0.065). In their turn, the rate of technical success in subgroups 2C and 2D was, respectively, 92.3% and 98.6% (p = 0.17). The rate of therapeutic success was 73% and 98.6% (p = 0.79). Conclusion Preoperative conventional AG should be reserved for cases where CTA cannot provide all the information in the planning of a therapeutic intervention.

scholarly journals A case report of moyamoya disease in children treated with encephalo-duro-myo-arterio-pericranial synangiosis

2021 ◽  
Author(s):  
Julius July
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Magnetic Resonance Angiography ◽  
Moyamoya Disease ◽  
Internal Carotid ◽  
Language Function ◽  
Vascular Networks ◽  
Ischemic Event ◽  
Special Challenge ◽  
Ischemic Attack

Moyamoya disease that manifests during childhood may pose a special challenge for surgeons. We report a case of a 10-year-old girl who suffered from moyamoya disease and was successfully treated with encephalo-duro-myo-arterio-pericranial synangiosis (EDMAPS). She presented with a recurrent transient ischemic attack that worsened for 1 year. She was aphasic globally (sensory and motor) and had slightly weak right extremities. Her magnetic resonance angiography and computed tomography angiography showed the typical features of moyamoya disease with bilateral stenosis at the terminal internal carotid artery, bilaterally abnormal vascular networks, and a left ischemic event involving the temporoparietal region. She was recovered well after underwent bilateral EDMAPS, fully regained her language function after 3 months, and gathered her strength back. Therefore, EDMAPS could be a good, safe, and effective treatment for moyamoya disease in children.

Computed tomographic angiography in stroke and high-risk transient ischemic attack: Do not leave the emergency department without it!

2018 ◽  
Vol 13 (7) ◽  
pp. 673-686
Author(s):  
Brett R Graham ◽  
Bijoy K Menon ◽  
Shelagh B Coutts ◽  
Mayank Goyal ◽  
Andrew M Demchuk
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Hemorrhagic Stroke ◽  
Computed Tomographic Angiography ◽  
Rapid Diagnosis ◽  
Vascular Lesions ◽  
Transient Ischemic Attacks ◽  
Computed Tomographic ◽  
Ischemic Attack ◽  
Tomographic Angiography

Stroke is a major cause of morbidity and mortality worldwide, and effective treatment requires rapid diagnosis and recognition of relevant vascular lesions. In this review we will discuss the usefulness and versatility of computed tomography angiography in the setting of stroke, be it ischemic or hemorrhagic, minor or disabling. Furthermore, we also highlight how we use computed tomography angiography in decision making in transient ischemic attacks, acute disabling ischemic stroke, and hemorrhagic stroke.

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