Dados do Trabalho

Título

Carotid Web: A Rare Finding Involved In Ischemic Stroke

RESUMO

Apresentação do Caso: A 70-year-old male with medical history of arterial hypertension, type 2 diabetes, hyperlipidemia and metastatic prostate cancer, presented with acute onset right-side weakness and global aphasia which had started 2 days before the admission in the hospital facility. Patient did not receive IV alteplase. CT revealed an acute infarct on the left temporoparietal lobe. Computed tomography angiography (CTA) described a linear structure in the posterior portion of the carotid bulb on the left side, suggestive of carotid web, partial occlusion of M1 segment of the left medial cerebral artery and in M2 e M3 segments as well, without other signs of atheromatosis or stenosis. No evidence of embolism was shown on the further investigation. The patient received aspirin 100mg and high-intensity statin therapy associated with strict control of risk factors, without intervention on the AFMD. In short-term follow-up, patient maintained the deficits. Discussão : Carotid web is considered an atypical variant of fibromuscular dysplasia (AFMD) and presents itself as an abnormal shelf-like intra-luminal projection of hyperplasia intima in the posterior wall of the proximal internal carotid artery, best visualized on CTA or carotid angiography. This finding has potential to cause blood stagnation, thromboembolism and distal embolization, with ongrowing evidence of stroke association, specially in younger patients, but also on hypercoagulable state, such as malignancy. Previous studies have shown that carotid web is found in up to 9.5% of patients <65 years of age with anterior circulation stroke of unknown cause. The incidence of AFMD in older patients with ischemic stroke is unknown. In patients with symptomatic carotid web, without other attributable causes of stroke, antiplatelet therapy is recommended to prevent recurrence. Carotid stenting or endarterectomy may be considered in refractory cases, based on limited data. Nevertheless, optimal management (medical or interventional) is unknown. Comentários Finais: The carotid web is a proposed stroke mechanism particularly in younger patients without vascular risk factors. However, it may have an important roll in older patients. Future studies involving diagnosis and secondary prevention of symptomatic AFMD should focus on all age spectrum and on the association with other risk factors.

Palavras Chave

"Stroke" "Fibromuscular Dysplasia" "Internal Carotid Artery"