Delayed Thrombus on Carotid Web: Case Report With Escalation of Treatment

2021 ◽  
pp. 194187442110589
Author(s):  
Thomas V. Kodankandath
Keyword(s):  
Ischemic Stroke ◽  
Case Report ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Ct Angiography ◽  
Stent Placement ◽  
Young Patients ◽  
Carotid Stenting ◽  
Definitive Treatment ◽  
Carotid Wall

Carotid artery web is an underrecognized source and is found in about 1-2% of patients with acute ischemic stroke. Although, first described four decades ago, optimal therapy for carotid web is not yet known. Carotid stenting and endarterectomy are increasingly used for carotid web treatment, given its definitive treatment and avoiding the complications associated with anticoagulation. The case reported here is of an ischemic stroke secondary to a mobile thrombus on a carotid web evident on CT angiography and successful definitive treatment with delayed carotid wall stent placement. In young patients who have a diagnosis of ischemic stroke, the carotid web should be on the differential and adequate neuroimaging with either CTA or DSA should be pursued.

scholarly journals Urgent carotid stenting before cardiac surgery in a young male patient with acute ischemic stroke caused by aortic and carotid dissection

2016 ◽  
Vol 73 (7) ◽  
pp. 674-678
Author(s):  
Rade Popovic ◽  
Sanja Radovinovic-Tasic ◽  
Sinisa Rusovic ◽  
Toplica Lepic ◽  
Radoje Ilic ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Aortic Dissection ◽  
Acute Ischemic Stroke ◽  
Young Patients ◽  
Carotid Stenting ◽  
Artery Dissection ◽  
Brachiocephalic Artery ◽  
The Right

Introduction. Acute aortic dissection (AD) is the most common life-threatening disorder affecting the aorta. Neurological symptoms are present in 17-40% of cases. The management of these patients is controversial. Case report. We presented a 37-year-old man admitted for complaining of left-sided weak-ness. Symptoms appeared two hours before admission. The patient had no headache, neither thoracic pain. Neurological examination showed mild confusion, left-sided hemiplegia, National Institutes of Health Stroke Scale (NIHSS) score was 10. Ischemic stroke was suspected, brain multislice computed tomography (MSCT) and angiography were performed and right intrapetrous internal carotid artery dissection noted. Subsequent color Doppler ultrasound of the carotid arteries showed dissection of the right common carotid artery (CCA). The patient underwent thoracic and abdominal MSCT aortography which showed ascending aortic dissection from the aortic root, propagating in the brachiocephalic artery and the right CCA. Digital subtraction angiography was performed subsequently and two stents were successfully implanted in the brachiocephalic artery and the right CCA prior to cardiac surgery, only 6 hours after admission. The ascending aorta was reconstructed with graft interposition and the aortic valve re-suspended. The patient was hemodynamically stable and with no neurologic deficit after surgery. Unfortinately, at the operative day 6, mediastinitis developed and after intensive treatment the patients died 35 days after admission. Conclusion. In young patients with suspected stroke and oscillatory neurological impairment urgent MSCT angiography of the brain and neck and/or Doppler sonography of the carotid and vertebral artery are mandatory to exclude carotid and aortic dissection. The prompt diagnosis permits urgent carotid stenting and cardiosurgery. To the best of our knowledge, this is the first published case of immediate carotid stenting in acute ischemic stroke after the diagnosis of carotid and aortic dissection and prior to cardiac surgery.

scholarly journals Neurointerventional management of carotid webs associated with recurrent and acute cerebral ischemic syndromes

2016 ◽  
Vol 22 (4) ◽  
pp. 432-437 ◽  
Author(s):  
AH Elmokadem ◽  
SA Ansari ◽  
R Sangha ◽  
S Prabhakaran ◽  
A Shaibani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Surgical Resection ◽  
Mechanical Thrombectomy ◽  
Carotid Stenting ◽  
Large Vessel ◽  
Definitive Treatment ◽  
Atheromatous Plaque ◽  
Left Middle Cerebral Artery ◽  
Computed Tomographic

Background A carotid web can be defined as an endoluminal shelf-like projection often noted at the origin of the internal carotid artery (ICA) just beyond the bifurcation. Diagnosis of a carotid web as an underlying cause of recurrent ischemic stroke is infrequent and easily misdiagnosed as an atheromatous plaque. Surgery has traditionally been used to resect symptomatic lesions while there is no enough evidence supporting medical therapy as the sole management. To our knowledge there is only one report about carotid artery stenting (CAS) as a definite management of carotid web and no previous reports of acute large-vessel occlusions undergoing mechanical thrombectomy in the setting of carotid web as the etiology. Case report We report two cases: The first presented with recurrent ischemic stroke in the same arterial territory and the other with an emergent left middle cerebral artery (MCA) occlusion that underwent endovascular mechanical thrombectomy in which initial computed tomographic angiograms (CTA) suggested carotid web etiologies. Following confirmation with digital subtraction angiography (DSA), both patients ultimately underwent endovascular carotid stenting instead of surgical resection for definitive carotid web treatment. Conclusions Carotid webs are a rare cause of ischemic stroke in young and middle-aged adults that can readily be identified by CTA. Endovascular management may include emergent mechanical thrombectomy for large-vessel thromboembolic complications, and for definitive treatment with carotid stenting across the carotid web as an alternative to surgical resection and medical management for secondary stroke prevention.

scholarly journals Ipsilateral internal carotid artery web and acute ischemic stroke: A cohort study, systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257697
Author(s):  
Brian Mac Grory ◽  
Erez Nossek ◽  
Michael E. Reznik ◽  
Matthew Schrag ◽  
Mahesh Jayaraman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Cryptogenic Stroke ◽  
Young Patients ◽  
Carotid Bifurcation ◽  
Stroke Patients

Introduction The carotid web is a compelling potential mechanism of embolic ischemic stroke. In this study, we aim to determine the prevalence of ipsilateral carotid web in a cohort of ischemic stroke patients and to perform a systematic review and meta-analysis of similar cohorts. Patients & methods We performed a retrospective, observational, cohort study of acute ischemic stroke patients admitted to a comprehensive stroke center from June 2012 to September 2017. Carotid web was defined on computed tomography angiography (CTA) as a thin shelf of non-calcified tissue immediately distal to the carotid bifurcation. We described the prevalence of carotid artery webs in our cohort, then performed a systematic review and meta-analysis of similar cohorts in the published literature. Results We identified 1,435 potentially eligible patients of whom 879 met criteria for inclusion in our analysis. An ipsilateral carotid web was detected in 4 out of 879 (0.45%) patients, of which 4/4 (1.6%) were in 244 patients with cryptogenic stroke and 3/4 were in 66 (4.5%) patients <60 years old with cryptogenic stroke. Our systematic review yielded 3,192 patients. On meta-analysis, the pooled prevalence of ipsilateral carotid web in cryptogenic stroke patients <60 was 13% (95% CI: 7%-22%; I2 = 66.1%). The relative risk (RR) of ipsilateral versus contralateral carotid web in all patients was 2.5 (95% CI 1.5–4.2, p = 0.0009) whereas in patients less than 60 with cryptogenic stroke it was 3.0 (95% CI 1.6–5.8, p = 0.0011). Discussion Carotid webs are more common in young patients with cryptogenic stroke than in other stroke subtypes. Future studies concerning the diagnosis and secondary prevention of stroke associated with carotid web should focus on this population.

scholarly journals Successful emergent carotid artery stent placement for high-grade stenosis in a serious ischemic stroke patient: Case report

Nosotchu ◽  
2007 ◽  
Vol 29 (5) ◽  
pp. 642-647
Author(s):  
Keisuke Imai ◽  
Masayoshi Kimura ◽  
Masahiro Makino ◽  
Fumiko Oshima ◽  
Kenichiro Oda ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Case Report ◽  
Carotid Artery ◽  
Stroke Patient ◽  
Stent Placement ◽  
High Grade ◽  
Ischemic Stroke Patient ◽  
Patient Case ◽  
Carotid Artery Stent

scholarly journals Acute Ischemic Stroke due to Common Carotid Ostial Disease with Tandem Intracranial Occlusions Treated with Thrombectomy and Staged Retrograde Stenting

2018 ◽  
Vol 7 (6) ◽  
pp. 445-451 ◽  
Author(s):  
Krishna Amuluru ◽  
Fawaz Al-Mufti ◽  
Charles E. Romero
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Carotid Stenting ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Treatment Techniques ◽  
Treatment Paradigm ◽  
The Common ◽  
Ostial Lesion

Background: Acute ischemic stroke due to tandem occlusive lesions of the anterior circulation involves an intracranial large vessel occlusion as well as a concurrent occlusion or high-grade stenosis of the proximal carotid system. The vast majority of proximal lesions in tandem occlusive cases involve the extracranial internal carotid artery, although the lesion can theoretically exist anywhere along the carotid artery pathway, including the common carotid ostium. Summary: To the best of our knowledge, only 1 report describes common carotid artery ostial lesions in the setting of acute ischemic stroke due to tandem occlusions, in which the authors describe an anterograde treatment paradigm. We present the first 2 cases of acute ischemic stroke secondary to common carotid ostial disease with tandem intracranial occlusion, treated with intracranial thrombectomy followed by subsequent staged balloon-mounted stenting of the common carotid ostium. We review the pathophysiology of tandem occlusions, the controversy surrounding treatment techniques, and various approaches used in the treatment of ostial occlusive lesions. Key Message: In certain situations where acute carotid stenting is not safe or technically possible, immediate intracranial thrombectomy with a subsequent staged balloon-mounted stenting of the ostial lesion may be a reasonable and safe option.

scholarly journals Endovascular stenting for the treatment of acute ischemic stroke due to spontaneous carotid artery dissection: case report

2013 ◽  
Vol 7 (4) ◽  
pp. 252-258 ◽  
Author(s):  
Ichiro SUZUKI ◽  
Yasushi MATSUMOTO ◽  
Toshio KIKUCHI ◽  
Ryushi KONDO ◽  
Yukako YAZAWA ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Case Report ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Endovascular Stenting
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