ABSTRACT
Objective:
To analyze the clinical characteristics and management strategy of carotid web (CW)-related
stroke and improve the
understanding of CW.
Methods:
The clinical data of 6
patients with CW-related
stroke treated at Xuanwu
Hospital,
Capital Medical
University, from January 2018 to September 2022 were retrospectively analyzed. Relevant data included clinical manifestations, bronchial
magnetic resonance imaging (MRI),
CT angiography (
CTA)/
digital subtraction angiography (DSA),
carotid ultrasonography, and transcranial
color-coded Doppler sonography (TCCD).
Treatments and follow-ups were also reported.
Results:
All 6
patients were middle-
aged or young, without traditional
risk factors for
cerebrovascular disease. The
male-to-
female ratio was 2∶4. All
patients had recurrent
strokes, with a score of 2-4 on the
National Institutes of Health Stroke Scale at the
time of onset.
Head MRI showed 5
patients with
cerebral infarction in the
middle cerebral artery supply area; 1
patient had no intracranial
infarction. No significant
stenosis of the vessels at the site of the CW was observed in any of the 6
patients. Four
patients had ipsilateral
stenosis or occlusion of the
middle cerebral artery, 1
patient had microembolic signals in the
middle cerebral artery, and 1
patient had no significant
abnormalities in the intracranial
artery. All 6
patients were initially diagnosed by ultrasound.
Diagnoses were confirmed by
CTA/DSA in 5 cases; the other
patient did not show any significant
abnormalities. All 6
patients underwent a
carotid endarterectomy after a pathological examination to confirm the
diagnosis. Postoperatively, regular antiplatelet aggregation and
statin lipid-lowering
therapies were administered. A follow-up of 0.5 to 5.2 years showed no
stroke recurrence in any
patient.
Conclusions:
CW-related
stroke is a rare cause of
cryptogenic stroke and has a high
recurrence rate. For
stroke patients who do not have traditional
risk factors for
cerebrovascular disease while repeatedly experiencing embolic events of the
internal carotid artery system,
attention should be paid to the combination of the carotid and
cerebral arteries, and comprehensive
hemodynamic characteristics should be checked for the presence of a CW.
Carotid artery ultrasound and TCCD combined with other imaging
methods can improve the
detection rate of a CW. Simple antiplatelet aggregation
therapy cannot effectively prevent
stroke recurrence. For
patients with confirmed CW-related
cerebral infarction, surgical resection can be performed, and the
treatment effect can be evaluated using
ultrasonography.
