Abstract Details

Title Management of Ischemic Stroke Due to Carotid Web: A Case Report Highlighting Endovascular Treatment and the Need for Consensus Guidelines

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 14-003

Objective Carotid web (CaW) is a rare form of fibromuscular dysplasia with an incidence <1% and has been linked to ischemic stroke, especially in young adults and African Americans. This topic has gained more attention recently as a potential cause of Embolic stroke of undetermined source (ESUS). The incidence of CaW among younger patients with cryptogenic stroke is 13%. The recurrence risk of ischemic stroke can be as high as 30%, even on dual antiplatelet therapy. Identifying CaWs as a cause of ischemic stroke is crucial for a more tailored management approach.

Background

Case Discussion:

49-year-old presented with sudden onset right hemiparesis and dysarthria with an NIHSS of 16. CTA showed left M1 occlusion. IV TNK was given followed by thrombectomy with TICI 2B. DSA demonstrated luminal irregularity with significant contrast stagnation in the left carotid bulb, consistent with a CaW. Stroke workup revealed a small PFO on Transthoracic echocardiogram and a small provoked DVT in the femoral vein ipsilateral to femoral access. After thorough discussion, cardiac source or paradoxical embolic from DVT is ruled out. Given the CaW and the provoked DVT, we opted for anticoagulation for 3 months followed by carotid artery stenting with no stroke recurrence.

Several imaging modalities such as thin cut CT angiography, MRI Axial T2 images, and digital subtraction angiography can be helpful in diagnosing Caw. Magnetic Resonance Angiography (MRA) with contrast, Spin Echo, and cineFSE can demonstrate slow blood flow and atypical pulsatility near the CaW, creating turbulent blood flow and forming a potential substrate for recurrent thrombus formation. There is no clear consensus for secondary stroke prevention management for CaW. Antiplatelets are sufficient but short-term AC is needed for patients with carotid thrombus.

Design/Methods NA

Results NA

Conclusions This case highlights the importance of recognizing and appropriately managing CaW to reduce stroke recurrence in high-risk patients.

Authors/Disclosures
Sai Kumar Reddy Pasya, MD, MBBS PRESENTER	Dr. Pasya has nothing to disclose.
Prasanna Venkatesan Eswaradass, MD (University of Kansas Health System)	Dr. Eswaradass has nothing to disclose.
Michael G. Abraham, MD (The University of Kansas Health System)	Dr. Abraham has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stryker Neurovascular.

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