Carotid Webs: An Unusual Presentation of Fibromuscular Dysplasia

Abstract

Carotid webs are abnormal luminal projections at the carotid bulb associated with blood flow stasis, artery dissection, and subsequent complications. Carotid webs are considered to be a rare variant of fibromuscular dysplasia (FMD). Young individuals with symptomatic carotid webs are found to be associated with ischemic stroke. The incidence of the carotid web is low, and it is rarely reported. Only 150 cases of FMD have been reported so far. FMD is a noninflammatory and non-atherosclerotic arteriopathy. The most common arterial beds involved are renal and extracranial carotids. Presentation varies depending on the location of the arterial bed involved and disease severity. Clinical presentations range from minor headaches to severe headaches, resistant hypertension, acute coronary syndrome, transient ischemic attack, and in some cases, stroke. Diagnosis can be made through non-invasive methods, such as computed tomographic angiography, magnetic resonance angiography, or duplex ultrasonography or invasive imaging methods like catheter-based angiography. Treatment of FMD varies with disease presentation and its location. Asymptomatic carotid or vertebral arteries FMD should be monitored clinically and prescribed aspirin 81 mg daily for primary stroke prevention. Endovascular and surgical therapy with stents or coils is reserved for patients with aneurysms. We present a rare and interesting case of a 54-year-old female who presented with acute ischemic stroke in the setting of right carotid artery web, right internal carotid artery (ICA) thrombus with dissection, and possible pseudoaneurysm.

Prevalence of Cervical Artery Abnormalities on CTA in Patients with Spontaneous Coronary Artery Dissection: Fibromuscular Dysplasia, Dissection, Aneurysm, and Tortuosity

“…Additional work with even larger numbers of patients would be needed to confirm this association because this was identified in only a handful of patients and the prevalence of webs in a typical population is around 1%. 25,[28][29][30] While prior work has found the presence of carotid dissection in SCAD to be in the range of 2.5%-5%, the current study demonstrates a prevalence of more than twice that, suggesting that dissection is more common than previously suspected. 31,32 Nonetheless, the relatively low prevalence of dissection compared with FMD at a single time point examination in the current study may provide some reassurance of cerebrovascular risk for patient counseling for many patients.…”

“…The higher rate of carotid webs among patients with SCAD is important because this finding may also be related to FMD and is increasingly associated with otherwise cryptogenic strokes. 24,25 Some authors have suggested that webs represent rare variants of the intimal subtype of FMD. 26,27 However, an international consensus article reinforced webs as being likely distinct entities from FMD.…”

Upper Gastrointestinal Bleeding as the First Presentation of Eosinophilic Gastrointestinal Disease

“…Hematemesis and melena have been described as a symptom of EoE and EG/EGE in 3 different case series, occurring in 1.4% of children with EoE, 23% of children with EG, and 87.5% of infants with EGE (18)(19)(20). Furthermore, several case reports have reported hematemesis, melena, and hematochezia in the setting of EGID (3,5,8). Given the high variability of symptoms, high rates of GIB observed in 2 case series and the steadily increasing incidence of EGID, EGID should be considered in the differential diagnosis of GIB, especially in patients with suggestive characteristics.…”

“…A PubMed search with the keywords "hematemesis," "bleeding," "melena," "eosinophilic esophagitis," "eosinophilic gastritis," "eosinophilic gastroenteritis," and "eosinophilic colitis" was conducted and revealed 16 publications dating between 2007 and 2020 (3)(4)(5)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). A total of 26 patients, between 1 day and 75 years of age, who presented with UGIB or LGIB and received an EGID diagnosis, were identified.…”

International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches

“…A carotid web is identified as a small, (curvi)lineair soft tissue density protruding into the carotid lumen usually at the level of the carotid bulb [105,106]. According to some authors, it represents a variant of fibromuscular dysplasia and is associated with an increased risk for stroke, especially in younger patients without classic vascular risk factors [107].…”