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Lodged Thrombus: A Pitfall for Diagnosing Carotid Web Using Contrast-Angiography
Yoshitaka Yamaguchi1, Kei Miyata2, Fumiki Tomeoka1
1Department of Cerebrovascular Medicine, Teine Keijinkai Hospital, Sapporo, JPN.
Cureus
|November 25, 2024
Summary
Carotid webs, a cause of stroke, can be missed by standard imaging. Carotid ultrasonography successfully diagnosed a symptomatic carotid web obscured by a thrombus, enabling timely treatment.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Carotid web (CaW) is a congenital anomaly causing cryptogenic ischemic stroke.
- Diagnosis typically involves digital subtraction angiography (DSA) or 3D-CT angiography.
- Thrombus formation within the carotid bulb is a complication of CaW.
Observation:
- A symptomatic carotid web was not diagnosed by DSA or 3D-CT angiography due to a large thrombus.
- Carotid ultrasonography revealed a membrane-like structure and lodged thrombus.
- The patient presented with hemiparesis and was diagnosed with acute cerebral infarction.
Findings:
- DSA and 3D-CT angiography showed only mild carotid bulb stenosis.
- Carotid ultrasonography identified a carotid web obscured by thrombus.
- Mechanical thrombectomy and carotid artery stenting were performed.
Implications:
- Carotid ultrasonography is crucial for diagnosing symptomatic CaW when DSA/3D-CT angiography are inconclusive due to thrombus.
- Early diagnosis and revascularization (CEA/CAS) reduce recurrent ischemic stroke risk.
- Multimodal imaging is essential to avoid missed CaW diagnoses in ESUS patients, especially those without vascular risk factors.
