Computed tomography myocardial perfusion imaging to detect myocardial ischemia in patients with anxiety and obstructive coronary heart disease post-exposure to mental stressors.

This study aims to measure myocardial blood flow (MBF) using dynamic CT- myocardial perfusion imaging (CT-MPI) combined with mental stressors in patients with obstructive coronary artery disease (OCAD) and in patients with anxiety and no obstructive coronary artery disease (ANOCAD). A total of 30 patients with OCAD with 30 patients with ANOCAD were included in this analysis. Using the 17-segment model, the rest and stress phase MBF of major coronary arteries in participants were recorded respectively. Compared with ANOCAD patients, OCAD patients were more likely to have localized reduction of MBF (p < 0.05). For patients with ANOCAD, both global MBF and MBF of the main coronary arteries in the stress phase were lower than those in the rest phase (all p < 0.05), but there was no significant difference in MBF among the main coronary arteries in the rest or stress phase (p = 0.25, p = 0.15). For patients with OCAD, the MBF of the target area was lower than that of the non-target area in both the rest and stress phase, and the MBF of the target area in the stress phase was lower than that in the rest phase (all p < 0.05). However, there was no significant difference in MBF between the rest or stress phase in the non-target area (p = 0.73). Under mental stress, the decrease in MBF in ANOCAD patients was diffuse, while the decrease in MBF in OCAD patients was localized. Dynamic CT-MPI combined with mental stressors can be used to detect MBF changes in anxiety patients.

Comparative Study of the Diagnostic Value of Zero-Echo-Time Magnetic Resonance Angiography With Time-of-Flight Magnetic Resonance Angiography for Intracranial Aneurysm.

OBJECTIVE: Intracranial aneurysm (IAN) is a class of cerebrovascular diseases with a serious threat to patients, and an accurate diagnosis of IAN is very important for both selection of the appropriate therapy and prediction of the prognosis. This study aimed to evaluate the diagnostic values of zero-echo-time magnetic resonance angiography (ZTE-MRA) and time-of-flight magnetic resonance angiography (TOF-MRA) in patients with IAN. METHODS: Digital subtraction angiography, ZTE-MRA, and TOF-MRA were performed in 18 patients diagnosed with IAN. The images of ZTE-MRA and TOF-MRA were compared for image quality, qualitative diagnosis, detailed diagnosis, number of thrombi, and residual aneurysm lumen, with digital subtraction angiography as the reference. RESULTS: Zero-echo-time MRA and TOF-MRA did not show a significant difference in image quality or detailed information (including aneurysm size, growth direction, and angle with the aneurysm-carrying vessel) ( P > 0.05). However, ZTE-MRA showed advantages over TOF-MRA in terms of qualitative diagnosis (sensitivity and specificity), intra-aneurismal thrombus detection, and residual aneurysm lumen detection after embolization ( P < 0.05). CONCLUSIONS: Compared with TOF-MRA, ZTE-MRA showed greater diagnostic value for IAN patients in terms of qualitative diagnosis, as well as the detection of intra-aneurysm thrombi and residual aneurysm lumen after embolization.

Impacts of obesity on global subclinical left cardiac function represented by CMR-derived myocardial strain, TyG index may be a predictor.

Obesity is a recognized risk factor for heart failure. People with similar weights may have different metabolic health. Notably, insulin resistance is a hallmark of obesity and a feature of heart failure. We aimed to evaluate the effects of obesity and metabolic health status on subclinical left cardiac function. We also investigated whether insulin resistance (TyG index) plays a role in BMI-linked subclinical left cardiac dysfunction. The study involved 403 volunteers. Hierarchical multiple regression models were used to assess associations between obesity, metabolic health, and overall subclinical left cardiac function. Mediating analysis was used to explore the role of the TyG index in the association between BMI and left cardiac function. Finally, ROC analysis was performed to explore the predictive value of the TyG index in subclinical left cardiac dysfunction. The correlation analysis showed that metabolic unhealth increased the risk of subclinical left ventricular (LV) dysfunction; obesity was associated with an increased risk of global left cardiac dysfunction regardless of metabolic health status. The TyG index mediated 25% of the associations between BMI and Left atrial (LA) functional parameters. ROC analysis exhibited that the TyG index can be used as a predictor of LA dysfunction (AUC = 0.63), and the optimal cut-off point for the TyG index is 9.33. Even a "non-obese metabolically unhealthy" is a detrimental state of early LV function; obesity remains a major risk factor for global subclinical left cardiac dysfunction. Using the TyG index could allow early identification of individuals at high risk of subclinical left cardiac dysfunction.Registration number: ChiCTR2200057991; Date of registration: 2022-03-25. URL: http://www.chictr.org.cn/showproj.aspx?proj=162316 .

Identification and quantitative evaluation of symptomatic cerebral venous thrombosis using 3D variable flip angle turbo spin echo.

PURPOSE: To explore the feasibility of MR 3D T1w Sampling Perfection with Application optimized Contrasts by using different flip angle Evolutions (SPACE) sequence imaging in symptomatic CVT diagnose, extracting the imaging features with quantitative analysis. METHODS: Fifty-nine patients with suspected CVT with neurological symptoms were retrospectively included in this study. Of them, 35 patients were enrolled in the comparation of diagnostic accuracy between the contrast-enhanced magnetic resonance venograms (CE-MRV) and 3D T1w SPACE imaging. Forty-five patients with 101 involved segments were identified for the quantitative analysis. All MR images were acquired on a 3.0 T MR scanner. The reference standard used in this study was a comprehensive combination of the imaging techniques and clinical information. CVT patients were grouped as acute (≤48 h), subacute (>48 h and ≤30d), and chronic (>30d) clinical phase. CVT segments were grouped based on pre-contrast T1WI, as type A: hypo intense signal; B: heterogeneously hyper intense signal; C: iso intense signal. The feasibility of 3D T1w SPACE imaging for diagnosing CVT was explored. Diagnostic accuracy of T1w SPACE imaging was analyzed and compared with the CE-MRV. The signal intensity of pre-contrast images (SpreCE), signal intensity of post-contrast images (SpostCE), and contrast enhancement (CE) rate, CE rate relative to that of pituitary gland (PG), white matter (WM), gray matter (GM), and normal vein vessel wall (nVVW) were compared based on both patients and segments. The CE rate grade of CVT segments of different imaging types was compared. RESULTS: The MR 3D T1w SPACE imaging achieved a higher sensitivity and specificity (100%/94.1% and 100%/100% based on patients/segments separately) than that of the CE-MRV (73.9%/56.9% and 83.3%/98.9% based on patients/segments separately). No statistical correlation was found between the imaging types of CVT segments and onset time of clinical symptoms (χ2 = 6.649, P = 0.171). Quantitative analysis showed that the CE rate relative to PG and that to WM were higher in the chronic CVT patients than that in the other two groups (H = 10.330 and P = 0.006, H = 9.898 and P = 0.007, separately). CE rate relative to GM in the chronic group was higher than that in the subacute group (H = 7.143 and P = 0.028). All of the quantitative parameters were statistically different across CVT segments of three imaging types (all P≤0.001). CONCLUSION: MR 3D T1w SPACE imaging has the advantage to accurately diagnose CVT of different clinical stages, and identify the involved thrombus segments.

Dynamic myocardial perfusion computed tomography with mental stress test to detect changes in myocardial microcirculation in patients with anxiety and no obstructive coronary artery disease.

OBJECTIVE: Mental stress can induce myocardial ischemia in patients with anxiety and other psychological disorders. Computed tomography myocardial perfusion imaging (CT-MPI) has the potential to quantitatively diagnose myocardial ischemia. The aim of this study was to measure changes in myocardial microcirculation perfusion (MMP) in patients with anxiety who have angina symptoms/ischemia but no obstructive coronary artery disease (INOCA) using dynamic CT-MPI in combination with a mental stress test. METHODS: Patients with INOCA were divided into five subgroups (none, minimal, mild, moderate, and severe) according to the generalized anxiety disorder scale. Patients underwent dynamic CT-MPI with mental stress testing using a series of the standardized color word/arithmetic stressors. Myocardial blood flow (MBF) during resting and stress phases of CT-MPI was recorded. RESULTS: Fifty-eight patients with 986 segments were included for final analysis. Compared to patients with none, minimal, mild, and moderate anxiety, those with severe anxiety had the largest rate of MBF decrease and the largest MBF decrease value. At the same time, those with no anxiety had the largest rate of MBF increase, the largest MBF increase value (all p < 0.05). As anxiety intensified, the rate of MBF increased and the MBF value increased (r = -0.24, r = -0.27, p < 0.05). Concomitantly, the rate of MBF decreased and the MBF value decreased (r = 0.63, r = 0.43, p < 0.05). CONCLUSIONS: Dynamic CT-MPI with a mental stress test can be used to evaluate MMP in patients with anxiety and INOCA. Mental stress resulted in significant differences in changes in the rate and value of MBF among patients with different anxiety degrees. KEY POINTS: • Dynamic CT-MPI with mental stress test worked well to quantitatively evaluate myocardial microcirculation perfusion in patients with anxiety and INOCA. • The rates of MBF decrease and MBF decrease value were positively correlated with anxiety degree of anxiety patients with INOCA. • MBF change derived from CT-MPI with mental stress test had a good performance to predicting anxiety degree of patients with anxiety and INOCA.

Machine learning-based CT radiomics model to discriminate the primary and secondary intracranial hemorrhage.

It is challenging to distinguish between primary and secondary intracranial hemorrhage (ICH) purely by imaging data, and the two forms of ICHs are treated differently. This study aims to evaluate the potential of CT-based machine learning to identify the etiology of ICHs and compare the effectiveness of two regions of interest (ROI) sketching methods. A total of 1702 radiomic features were extracted from the CT brain images of 238 patients with acute ICH. We used the Select K Best method, least absolute shrinkage, and selection operator logistic regression to select the most discriminable features with a support vector machine to build a classifier model. Then, a ten-fold cross-validation strategy was employed to evaluate the performance of the classifier. From all quantitative CT-based imaging features obtained by two sketch methods, eighteen features were selected respectively. The radiomics model outperformed radiologists in distinguishing between primary and secondary ICH in both the volume of interest and the three-layer ROI sketches. As a result, a machine learning-based CT radiomics model can improve the accuracy of identifying primary and secondary ICH. A three-layer ROI sketch can identify primary versus secondary ICH based on the CT radiomics method.

Predictive value of fibrinogen levels for 90-day functional outcomes after intravenous thrombolysis in patients with acute ischaemic stroke.

PURPOSE: We aimed to investigate the correlation between fibrinogen levels and functional outcomes at 90 days after intravenous thrombolysis therapy (IVT) in patients with acute ischaemic stroke (AIS). METHODS: We identified patients with AIS who received IVT (alteplase 0.6 or 0.9 mg/kg) between 1 January 2019 and 31 March 2022 in Yancheng 1st People's Hospital. Fibrinogen levels were measured before IVT, and the 90-day post-stroke functional outcome was evaluated using the modified Rankin Scale (mRS). An mRS score of 0-2 indicated functional independence, whereas an mRS score of 3-6 indicated functional dependence. Potential outcome predictors were evaluated using univariate and multivariate analyses, and receiver operating characteristic (ROC) curve analysis was performed to assess the performance of fibrinogen levels in predicting the 90-day outcome. RESULTS: A total of 276 patients with AIS who received IVT within 4.5 h of stroke onset were enrolled, of whom 165 and 111 were categorised into the functional independence and functional dependence groups, respectively. Univariate analysis showed that the fibrinogen, homocysteine, high-density lipoprotein cholesterol, and D-dimer levels; age; National Institutes of Health Stroke Scale (NIHSS) score on admission; NIHSS score 24 h after IVT; and incidence of cardioembolism were higher in the functional dependence group than in the functional independence group (P < 0.05). Meanwhile, the thrombin time and the incidence of small-vessel occlusion in the functional dependence group were smaller than those in the functional independence group (P < 0.05). Multivariate logistic regression analysis showed that fibrinogen and homocysteine levels were both independent risk factors for 90-day functional dependence in patients with AIS (odds ratio [OR] 2.822, 95% confidence interval [95% CI]: 1.214-6.558, P = 0.016 for fibrinogen; OR 1.048, 95 %CI: 1.002-1.096, P = 0.041 for homocysteine). The area under the ROC curve of fibrinogen levels before IVT for predicting poor functional outcomes was 0.664, with a sensitivity, specificity, positive predictive value, and negative predictive value of 40.9%, 80.8%, 68.9%, and 64.3%, respectively. CONCLUSION: In patients with AIS, fibrinogen levels have a certain predictive value for short-term functional outcomes after IVT.

Fast detection of dam zone boundary based on Otsu thresholding optimized by enhanced harris hawks optimization.

Earth-rock dams are among the most important and expensive infrastructure projects. A key safety issue is dam zone boundary detection to prevent the intrusion of materials from different zones. However, existing detection methods strongly highly depend on human judgement, which is time consuming and labor intensive. To solve this problem, this work proposes a fast boundary detection method based on the Otsu algorithm optimized by enhanced Harris hawks optimization (HHO). Compared with the original Otsu algorithm, the proposed method has a higher computation speed to meet the time requirements of engineering projects. Particle swarm optimization is adopted to enhance the exploration stage of HHO. In addition, a tangent function and chaotic sine map are used to improve the convergence speed and robustness. The application of the proposed method to a real-life project shows that the calculation time can be reduced to 20 s, which is approximately 18.8% of the original calculation time.

Association of sodium intake with adverse left atrial function and left atrioventricular coupling in Chinese.

OBJECTIVES: High sodium intake is strongly associated with hypertension and obesity. This study aims to investigate the relationship between 24-h urinary sodium (a surrogate measure of sodium intake), ambulatory blood pressure parameters, left atrial function, and left atrioventricular coupling. Further, we intend to examine whether blood pressure and BMI might be mediators of the relationship between 24-h urinary sodium and subclinical cardiac function. METHODS: Our study had 398 participants, all of whom were subjected to 24-h urine collection, 24-h ambulatory blood pressure measurement, and cardiac magnetic resonance imaging. RESULTS: The average age of the participants was 55.70 ±â€Š11.30 years old. The mean urinary sodium of the participants was 172.01 ±â€Š80.24 mmol/24 h. After adjusting for age, sex, history of diabetes, smoking status, alcohol consumption, and use of diuretics, 24-h urinary sodium was correlated with multiple ambulatory blood pressure parameters, BMI, left atrial function, and the left atrioventricular coupling index (LACI) (P < 0.05). Mediation analysis showed that BMI explained 16% of the indirect effect of 24-h urinary sodium and left atrial function and 30% of the indirect effect of LACI. Independent of the mediator, 24-h urinary sodium had a significant direct effect on left atrial function and left atrioventricular coupling. CONCLUSIONS: Higher 24-h urinary sodium was associated with a greater BMI as well as poor left atrial function and left atrioventricular coupling, and the BMI mediated the relationship between 24-h urinary sodium and subclinical left cardiac function. Furthermore, and more importantly, 24-h urinary sodium may have directly affected the left atrial function and left atrioventricular coupling independent of intermediary factors.

Peri-procedural variables and outcomes of long-period hemodynamic instability after carotid artery angioplasty and stenting.

OBJECTIVES: The aim of this study is to identify the peri-procedural risk factors and outcomes of hemodynamic instability (HI) after carotid artery stenting (CAS). METHODS: A single-center, retrospective study was performed in 168 patients who underwent CAS procedure between September 2017 and September 2020. The presence of HI, as defined by hypertension (systolic blood pressure >160 mmHg), hypotension (systolic blood pressure <90 mmHg), and/or bradycardia (heart rate <60 bpm), was recorded. Long-period HI was defined as persistent HI lasting more than 24 h. Patient demographics, comorbidities, peri-procedural variables, and risk factors were recorded. Clinical outcomes including cerebral hyperperfusion syndrome, hemorrhage, transient ischemic attack (TIA), stroke, myocardial infarction, and mortality within 30 days of the procedure were evaluated. Logistic regression was used to analyze the independent risk factors of long-period HI following CAS. RESULTS: Among 168 patients (mean age, 68.2 ± 8.3 years; 81.5% male), the frequency of post-procedural long-period HI was noted in 42 patients (25.0%). Male was prone to experience HI (odds ratio, 9.156, p = 0.021). Aggressive inflation pressure (>7 atm) and 5 mm balloon for pre-dilatation were risk factors of long-period HI (OR, 7.372, p = 0.035; OR, 3.527, p = 0.023). Intraoperative peak blood pressure and larger-sized stents remained independent predictors for the development of HI (OR, 1.043, p = 0.027, and OR, 1.973, p = 0.015). Patients with prolonged HI were more likely to suffer TIA and stroke compared to other patients and significant difference was found in the occurrence of TIA (p < 0.05). Non-significance was found in mortality rate and other outcomes. CONCLUSIONS: CAS-induced HI occurs in a considerable percentage while several peri-procedural variables are determined as independent predictors to develop long-period HI. Patients with prolonged HI are associated with increased risk of neurologic events and thus standardized intervention as well as management of long-period HI are of critical importance during clinical process.

Rechargeable Aqueous Mn-Metal Battery Enabled by Inorganic-Organic Interfaces.

Aqueous batteries that use metal anodes exhibit maximum anodic capacity, whereas the energy density is still unsatisfactory partially due to the high redox potential of the metal anode. Current metal anodes are plagued by the dilemma that the redox potential of Zn is not low enough, whereas Al, Mg, and others with excessively low redox potential cannot work properly in aqueous electrolytes. Mn metal with a suitably low redox potential is a promising candidate, which was rarely explored before. Here, we report a rechargeable aqueous Mn-metal battery enabled by a well-designed electrolyte and robust inorganic-organic interfaces. The inorganic Sn-based interface with a bottom-up microstructure was constructed to preliminarily suppress water decomposition. With this bubble-free interface, the organic interface can be formed via an esterification reaction of sucrose triggered by acyl chloride in the electrolyte, generating a dense physical shield that isolates water while permitting Mn2+ diffusion. Hence, a Mn symmetric cell achieves a superior plating/stripping stability for 200 hours, and a Mn||V2 O5 battery maintains approximately 100 % capacity after 200 cycles. Moreover, the Mn||V2 O5 battery realizes a much higher output voltage than that of the Zn||V2 O5 battery, evidencing the possibility of increasing the energy density through using a Mn anode. This work develops a systematic strategy to stabilize a Mn-metal anode for Mn-metal batteries, opening a new door towards enhanced voltage of aqueous batteries.

Study on the Correlation Between Ischemic Leukoaraiosis and Cerebral Large Artery Stenosis Using the Stages of the Preinfarction Period Based on the Result of Computed Tomography Perfusion.

BACKGROUND AND OBJECTIVE: The influence of cerebral large artery stenosis (CLAS) on ischemic leukoaraiosis (LA) remains elusive. Based on the proposed stages of the preinfarction period, this study aimed to adopt the staging system to assess the correlation between ischemic LA and CLAS. MATERIALS AND METHODS: Patients with unilateral CLAS ≥50% and without cerebral stroke were screened. The severity and distribution of stenosis were evaluated on computed tomography angiography images. The degree of regional cerebral perfusion was rated according to the stages of preinfarction period: 0=normal, 1=stage Ia, 2=stage Ib, 3=stage IIa, 4=stage IIb. Stage I included stage Ia and stage Ib. Stage II included stage IIa and stage IIb. LA was scored with Fazakas scale on T2-weighted image and/or fluid-attenuated inversion recovery sequences. RESULTS: The cohort consisted of 212 patients (mean age, 66.89±11.39 y), including 145 (68.40%) males. CLAS severity and distribution did not differ between patients with and without LA (P>0.05). Normal, stage I, and stage II had significantly different incidences of LA and hemispheric LA scores in the left and right hemispheres (P<0.05). The degree of regional cerebral perfusion was independently associated with LA in the left (P=0.0094) and right hemispheres (P=0.0091). CONCLUSIONS: Ischemic LA is not directly related to CLAS but is independently associated with the degree of CLAS-induced cerebral hypoperfusion. The stages of the preinfarction period are helpful in identifying people at high risk of LA progression.

Recanalization of symptomatic chronic internal carotid artery occlusions by hybrid treatment.

OBJECTIVE: To evaluate the efficacy and safety of hybrid revascularization by carotid endarterectomy and endovascular intervention in the treatment of chronic internal carotid artery occlusion (ICAO). METHODS: We performed a retrospective analysis of patients who received hybrid treatment for symptomatic chronic ICAO between December 2016 and December 2018. Fifty-six patients with long-segment ICAO were enrolled and divided into the short duration (1-3 months) and long ICAO duration (>3 months) groups, and their clinical and angiographic data were analyzed. RESULTS: The mean duration was 106.8 ± 36.1 days from the date of ICAO diagnosis to revascularization. Totally, 10 patients (17.8%, n = 56) in the short duration group while no patients in the long duration group failed recanalization (n = 7). Perioperative complications included intraoperative thromboembolism in 1 (1.8%) patient and subarachnoid hemorrhage in 2 (3.6%) patients. Early phase postoperative hypertension was noted in 11 (19.6%) patients and cervical hemorrhage in 1 (1.8%) patient. No severe neurological deficits occurred. Overall, the 6-month modified Rankin score, Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in patients with successful recanalization significantly improved versus the baseline (P < 0.05). After successful recanalization, the long duration group demonstrated more stents for revascularization compared with the short duration group (P < 0.05). Five (10.8%) patients had recurrent transient ischemic attack, and 1 (2.2%) patient developed stroke in the successful revascularization group during 6 months of follow-up. ICA restenosis occurred in 5 (8.9%) patients and re-occlusion was noted in 1 (1.8%) patient. CONCLUSIONS: Hybrid operation may be feasible and effective for patients with symptomatic chronic complete ICAO according to our limited data. The original occlusion site from the carotid bifurcation and the duration of ICAO should be considered as independent indicators for successful recanalization as well as perioperative outcomes.

Asymmetric pathological pachymeningeal enhancement: A new imaging feature for cerebral venous thrombosis.

PURPOSE: Cerebral venous thrombosis (CVT) has various clinical presentations and has a median onset delay of 7 days. So it is important to find more identifiable early imaging manifestations for CVT. METHOD: This was a retrospective study. Patients with CVT (CVT group, n = 26) diagnosed by conventional imaging techniques (magnetic resonance imaging and/or digital subtraction angiogram) and patients with symptomatic intracranial atherosclerosis (control group, n = 30) were included. Magnetic resonance black-blood thrombus imaging (MRBTI) technique had been performed in both groups. The CVT group was divided into 3 groups based on the duration of clinical onset: ≤7 days (group 1), between 7 and 30 days (group 2), and >30 days (group 3). Pathological pachymeningeal enhancement and its characteristics were analyzed between the CVT group and the control group. RESULTS: Pathological pachymeningeal enhancement was found in 14 CVT patients (54 %) and none in control group (P value = 0.000). The bilateral pathological pachymeningeal enhancement was involved in 10 CVT patients, 6 patients were asymmetric, and 4 patients had ipsilateral enhancement. Asymmetric pathological pachymeningeal enhancement was 71 % and predominantly located on the thrombosed sinus side. Strong enhancement was found in the venous sinus wall beside the thrombus. Pathological pachymeningeal enhancement percentages of three subgroups were 75 % in group 1, 55 % in group 2, and 29 % in group 3 and had no statistical differences (p value = 0.198). CONCLUSIONS: Current findings suggest asymmetrical pathological pachymeningeal enhancement was associated was CVT and may be a new imaging feature for CVT.

Acyl-CoA synthetase long chain family member 4 plays detrimental role in early brain injury after subarachnoid hemorrhage in rats by inducing ferroptosis.

AIMS: Acyl-CoA synthetase long chain family member 4 (ACSL4) is closely related to tumor genesis and development in certain tissues. However, the function of ACSL4 in early brain injury (EBI) caused by subarachnoid hemorrhage (SAH) is unclear. In this study, we investigated the expression patterns and role of ACSL4 in SAH and post-SAH EBI using a rat model of SAH. METHODS: The rat model of SAH was induced by autologous blood injection into the prechiasmatic cistern of rats. We also used two specific inhibitors of ferroptosis (Ferrostatin-1 and Liproxstatin-1) to investigate the role of ferroptosis in EBI. RESULTS: We found that ACSL4 levels in brain tissue increased significantly in post-SAH EBI. Inhibiting the expression of ACSL4 using small interfering RNAs alleviated inflammation, blood-brain barrier (BBB) impairment, oxidative stress, brain edema, and behavioral and cognitive deficits, and increased the number of surviving neurons, after SAH. Similar effects were obtained by suppressing ferroptosis. CONCLUSIONS: ACSL4 exacerbated SAH-induced EBI by mediating ferroptosis. These findings may provide a theoretical basis for potential therapy aimed at alleviating post-SAH EBI.

Carotid Web Misdiagnosis.

BACKGROUND: A carotid web (CW), an atypical fibromuscular dysplasia, is rare and may cause ischemic stroke. It is challenging to recognize a CW promptly and treat it accordingly. We report a case of an initially misdiagnosed CW. CASE DESCRIPTION: A 48-year-old man with recurrent cerebral infarction was transferred to our hospital for bypass surgery. Imaging performed at our facility showed multiple old infarct lesions and cerebral tissue hypoperfusion in the occluded left middle cerebral artery territory. Bypass surgery was performed without perioperative complications. While searching for the cause of his stroke, we found a thin intraluminal filling defect along the posterior wall of the left carotid bulb just beyond the carotid bifurcation on sagittal maximal intensity projection images, axial thin-cut images, and volume rendering images. The defect was diagnosed as a CW. It was also detected on follow-up ultrasonography. Owing to our initial unawareness, we did not photograph the carotid bulb during preoperative digital subtraction angiography and postoperative computed tomography angiography. Although the patient was treated with bypass, the persistence of the factors underlying the CW may induce further thrombosis and subsequent occlusion of his ipsilateral anterior cerebral artery. CONCLUSIONS: Clinicians should be aware of CW as a potential cause of ischemic stroke. Head and neck computed tomography angiography is a reliable imaging method to detect CWs.