Embolectomy of acute embolic stroke associated with ipsilateral carotid web: a case report and literature review

Abstract

A carotid web is a thin intraluminal protrusion located in the posterolateral wall of the carotid bulb, which might be a risk factor for cryptogenic stroke. The mechanism of ischemic stroke caused by carotid web is still unclear, but it might be related to hemodynamic changes distal to the web, resulting in flow forces and remote embolization of fibrin-based clots. The diagnosis of a carotid web mainly depends on carotid artery imaging examinations. The main therapeutic strategies include medical treatment with oral antiplatelet agents and anticoagulants, and operative treatment, such as carotid endarterectomy and carotid artery stenting. Few cases of acute large-vessel occlusion undergoing mechanical thrombectomy in the setting of carotid web as the etiology have been reported. We report here a case of a 37-year-old woman who underwent stent retriever embolectomy after acute ischemic stroke. Carotid artery imaging examinations, including digital subtraction angiography and magnetic resonance imaging, and pathology showed that a carotid web was located at the proximal right internal carotid artery. We also discuss the clinical pathophysiological and imaging features, and the treatment of carotid web as described in the currently available literature.

Histopathological Examination of a Symptomatic Carotid Web: A Case Report

“… 5 ) A cohort study also demonstrated that among seven (29%) patients with symptomatic CaWs exhibiting a recurrent ischemic stroke, three were already taking antiplatelet monotherapy and two were using dual antiplatelet therapy. 6 ) Only a few reports have angiography findings, indicating an overlying thrombus trapped in the CaW, and the thrombus disappeared under anticoagulation therapy Several reports have advocated that a thrombus might respond best to anticoagulation therapy 1 , 2 , 7 ) because blood stagnation may lead to thrombus formation distal to the CaW, followed by artery-to-artery embolism; this mechanism of thrombus formation could be similar to the mechanisms of thrombus formation in the left atrial appendage. We confirmed that antiplatelet therapy did not play a role in preventing either thrombus formation or stroke recurrence.…”