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Carotid web: the challenging diagnosis of an under-recognized entity

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Abstract

Background

Determining the cause of acute ischemic stroke is crucial for patient management, particularly for preventing future stroke. In recent years, carotid web (CW), a non-atherosclerotic disorder of the carotid wall, has been found to be an underestimated source of cerebral emboli.

Objective

The present study aimed to analyze the clinical, radiological, and pathological findings, along with the treatments performed in patients with CW and ipsilateral ischemic events.

Methods

Patients with anterior circulation ischemic stroke or transient ischemic attack and ipsilateral CW were prospectively included from January 2019 to December 2021.

Results

Nine patients were enrolled. The median age was 55 (43–62) years, with a female-to-male ratio of 3.5:1. Of the total, seven patients (78%) consulted for recurrent ipsilateral ischemic events. Despite medical treatment, 44% of the patients experienced new episodes. Computed tomographic angiography was suggestive of CW in all cases in which it was performed. The interval between the first ischemic event and diagnosis of CW was of 13 (6–68) months. After ruling out any other possible etiology, every patient underwent carotid revascularization, one underwent stenting and eight underwent carotidectomy. No severe or long-term complications were noted. Histological studies confirmed the diagnosis of CW. There were no recurrences after carotid revascularization during a follow-up of 24 (13–35) months.

Conclusion

Knowledge of CW and differentiating it from atheroma plaques is essential, as medical management seems to be insufficient in many cases. Revascularization, which has been shown to be safe and effective, might be the best treatment modality.

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Data availability

Anonymized data for this study are available from the corresponding author upon request from any qualified investigator.

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Funding

No funding was received.

Author information

Authors and Affiliations

  1. Stroke Unit, Department of Neurology, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa Travesa da Choupana, s/n, 15706, Santiago de Compostela, Spain

    Emilio Rodríguez-Castro, Susana Arias-Rivas, María Santamaría-Cadavid, Iria López-Dequidt & Manuel Rodríguez-Yáñez

  2. Department of Neuroradiology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain

    Antonio Jesús Mosqueira, Miguel Blanco Ulla, Fernando Vázquez Herrero, José Antonio Castiñeira & José Manuel Pumar

  3. Department of Pathology, Vall d’Hebron University Hospital, Barcelona, Spain

    Elena Martínez-Sáez

  4. Department of Pathology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain

    Edurne Pérez Béliz & Máximo Fraga

  5. Department of Angiology and Vascular Surgery, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain

    Nilo Mosquera & Diego Caicedo

  6. Department of Forensic Sciences, Pathology, Gynecology and Obstetrics, and Pediatrics, Faculty of Medicine of Santiago de Compostela, Santiago de Compostela, Spain

    Máximo Fraga

  7. President of Sociedad Íbero Latino Americana de Neurorradiología Diagnóstica y Terapéutica (SILAN), Barcelona, Spain

    José Manuel Pumar

  8. Chair of Interventional Neuroradiology of the University of Santiago de Compostela (CINIUS), Santiago de Compostela, Spain

    José Manuel Pumar

Authors
  1. Emilio Rodríguez-Castro
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  2. Susana Arias-Rivas
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  3. María Santamaría-Cadavid
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  4. Iria López-Dequidt
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  5. Manuel Rodríguez-Yáñez
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  6. Antonio Jesús Mosqueira
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  7. Miguel Blanco Ulla
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  8. Fernando Vázquez Herrero
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  9. José Antonio Castiñeira
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  10. Elena Martínez-Sáez
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  11. Edurne Pérez Béliz
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  12. Nilo Mosquera
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  13. Diego Caicedo
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  14. Máximo Fraga
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  15. José Manuel Pumar
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Contributions

All authors of this work met ICMJE criteria for authorship and made substantial contributions to the conception and design, acquisition, analysis and interpretation of data, drafting, critical revising, and final approval of this manuscript.

Corresponding author

Correspondence to Emilio Rodríguez-Castro.

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Conflict of interests

None declared.

Financial and non-financial interests

None to disclose.

Ethics approval

This study was approved by our Local Ethical Committee (ID 2022/131) and the authors certify that it was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to publish

Informed consent was obtained from all individual participants included in the study.

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Rodríguez-Castro, E., Arias-Rivas, S., Santamaría-Cadavid, M. et al. Carotid web: the challenging diagnosis of an under-recognized entity. J Neurol 269, 5629–5637 (2022). https://doi.org/10.1007/s00415-022-11210-y

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  • DOI: https://doi.org/10.1007/s00415-022-11210-y

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