Abstract Details

Title A Tangled, Clotted Web: Multi-modal imaging of a thrombosed carotid web

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-018

Objective To illustrate the importance of multimodal imaging to characterize atypical vascular lesions when evaluating a low-risk patient with cryptogenic stroke.

Background A 59-year-old female with well-controlled hypertension and hyperlipidemia presents with acute-onset aphasia after a fall. Her aphasia presented with errors in repetition, naming, and command following. Her motor exam demonstrated 5/5 strength in all extremities. Sensation was intact. Risk stratification labs revealed an LDL of 62, TSH 3.01, A1C of 4.9%. She was normotensive, afebrile, and had a BMI of 20.9. She has a previous smoking history of 10 pack years.

Design/Methods N/A

Results Initial CT imaging identified a right subdural hematoma (SDH) without evidence of infarction. CTA revealed a left M2 occlusion with an 18-cc penumbra, and a focal plaque/filling defect in the left ICA bulb thought to be related to an underlying carotid web. She was out of tPA window, and the distal lesion was not amenable to thrombectomy. MRI revealed acute infarcts in the left temporoparietal and right inferior parietal lobes. Carotid ultrasound demonstrated the absence of stenotic flow and confirmed a thrombosed carotid web. Her acute SDH prevented anticoagulation treatment of the thrombus. A right MMA embolization and carotid angiogram with stent was performed for definitive treatment, given the risk of further embolization. The thrombosed web was visualized during the catheter angiogram. Her aphasia improved throughout her hospitalization, and she is currently receiving speech therapy.

Conclusions

Carotid webs are anatomical variants, found on imaging, associated with thrombus formation and ischemic stroke due to the disruption of laminar flow. In patients without typical CVA risk factors, it is essential for the multidisciplinary treatment team to use multimodal imaging and consider a thrombosed carotid web as a potential etiology. Multimodal imaging allows for more definitive characterization of atypical lesions and in this case confirmed the thrombus associated with the web.

Authors/Disclosures
Rebecca Merrill, MD PRESENTER	Ms. Merrill has nothing to disclose.
Ian J. Kinney	Mr. Kinney has nothing to disclose.
	No disclosure on file
Patrick S. Reynolds, MD, FAAN (Wake Forest University Health Sciences)	Dr. Reynolds has nothing to disclose.

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