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Título

“Carotid web” an important etiology of stroke in young people: case report.

RESUMO

J.A.T.T, male, 44 years old, has prothrombin II mutation. Attended at Albert Einstein Hospital on April 21, 2022 with dysarthria lasting 5 minutes one day before admission. He denies motor or sensory deficits. On admission, cranial CT and AngioCT identified areas of recent infarction in the subcentral and right inferior frontal gyrus associated with linear and irregular filling failure adhered to bulb wall/origin of right internal carotid artery (ICA), suggestive of carotid membrane with associated thrombus, typical of “carotid web”. The findings were confirmed with MRI and AngioMRI with vessel studies that showed occlusion of the M4 segment of the right middle cerebral artery. Angioplasty with stent was performed on April 24, without complications. The patient evolved without changes in the neurological examination, using full anticoagulation. Discussion: “Carotid web” (CA-Web) is defined as thin, linear, membrane that extends from the posterior aspect of the internal carotid artery bulb into lumen, located just beyond the carotid bifurcation. Histopathologically is characterized by fibroelastic thickening of the arterial intima. Prevalence is estimated ranging from 9.4% to 37% in patients with cryptogenic stroke. Studies showed average age of 41 years and an NIH of 10.5 in patients with this vascular disorder. Thus, symptomatic CA-Web patients are younger and likely to have more severe strokes compared to ischemic stroke patients in general. Among the non-invasive diagnostic methods, there is AngioCT which Ca- Web is usually seen as a thin, smooth, membrane-like intraluminal filling defect along the posterior wall of the ICA bulb on oblique sagittal images. Treatment is based on secondary prevention of stroke, as well as an individualized anticoagulation decision, as the risk of recurrent ischemic events is likely to be higher in antiplatelet therapies. Surgical resection can be considered, especially for patients with therapeutic failure, and carotid artery stents are alternative to surgical resection, with a lower risk of complications. Conclusion: CA-web is rare variant of fibromuscular dysplasia that affects the carotid artery intima. Recent studies have associated this change as important etiology in young patients with cryptogenic ischemic stroke. The knowledge about radiographic findings, as well as management in the treatment of this etiology can prevent recurrence of ischemic vascular accidents, especially in the young population.

Palavras Chave

“carotid web”, ischemic stroke, cryptogenic stroke, anticoagulation.