Internal Carotid Artery Web as the Cause of Recurrent Cryptogenic Ischemic Stroke

J Stroke Cerebrovasc Dis. 2018 May;27(5):e86-e87. doi: 10.1016/j.jstrokecerebrovasdis.2017.12.012. Epub 2018 Jan 10.

Abstract

Carotid artery web is considered an exceptional cause of recurrent ischemic strokes in the affected arterial territory. The underlying pathology proposed for this entity is an atypical fibromuscular dysplasia. We present the case of a 43-year-old woman with no cardiovascular risk factors who had experienced 2 cryptogenic ischemic strokes in the same arterial territory within an 11-month period. Although all diagnostic tests initially yielded normal results, detailed analysis of the computed tomography angiography images revealed a carotid web; catheter angiography subsequently confirmed the diagnosis. Carotid surgery was performed, since which time the patient has remained completely asymptomatic. The histological finding of intimal hyperplasia is consistent with previously reported cases of carotid artery web. Carotid artery web is an infrequent cause of stroke, and this diagnosis requires a high level of suspicion plus a detailed analysis of vascular imaging studies.

Keywords: Web; atypical fibromuscular dysplasia; cryptogenic stroke; diaphragm.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aspirin / therapeutic use
  • Atorvastatin / therapeutic use
  • Biopsy
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / etiology*
  • Cardiovascular Agents / therapeutic use
  • Carotid Artery Diseases / complications*
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / drug therapy
  • Carotid Artery Diseases / pathology
  • Carotid Artery, Internal / diagnostic imaging
  • Carotid Artery, Internal / drug effects
  • Carotid Artery, Internal / pathology*
  • Computed Tomography Angiography
  • Female
  • Fibromuscular Dysplasia / complications*
  • Fibromuscular Dysplasia / diagnostic imaging
  • Fibromuscular Dysplasia / drug therapy
  • Fibromuscular Dysplasia / pathology
  • Humans
  • Hyperplasia
  • Neointima
  • Recurrence
  • Risk Factors
  • Stroke / diagnostic imaging
  • Stroke / etiology*

Substances

  • Cardiovascular Agents
  • Atorvastatin
  • Aspirin