Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.20240126
Jornal Vascular Brasileiro
Case Report

Membrana carotídea: uma etiologia pouco conhecida de acidentes vasculares cerebrais recorrentes - relato de caso

Carotid web: a little-known etiology of recurrent stroke - case report

Nathalia Santana Moreda; Henrique Alves de Almeida; Vinicius Tadeu Ramos da Silva Grillo

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Resumo

A membrana carotídea (MC) é uma condição rara e pouco compreendida associada a acidente vascular isquêmico (AVCi) criptogênico e recorrente em pacientes jovens sem fatores de risco ateroscleróticos. Descrevemos o caso de uma paciente do sexo feminino, com 58 anos, hipertensa, dislipidêmica e com quadro de AVCis há 5 anos. A presença de MC foi sugerida pela ultrassonografia Doppler e confirmada pela angiografia por subtração digital. A paciente foi submetida a endarterectomia e, devido ao refluxo satisfatório da carótida interna, optou-se por não utilizar shunt vascular temporário. Procedeu-se com a endarterectomia e arteriorrafia com patch de pericárdio bovino. Embora a MC possa ser visualizada por meio de exames de imagem, sua detecção pode ser desafiadora, podendo mimetizar outras condições, como dissecção arterial, placa aterosclerótica não calcificada e trombo intraluminal. A facilidade com que a MC pode passar despercebida ou ser mal diagnosticada ressalta a necessidade da compreensão desta doença.

Palavras-chave

doenças das artérias carótidas; AVC isquêmico; endarterectomia de carótida

Abstract

Carotid web is a rare and poorly understood condition associated with cryptogenic and recurrent acute ischemic stroke in young patients without atherosclerotic risk factors. We describe the case of a 58-year-old female patient with hypertension and dyslipidemia who had recurrent ischemic strokes for 5 years. Presence of carotid web was suggested by Doppler ultrasonography and confirmed by digital subtraction angiography. The patient underwent endarterectomy and, due to satisfactory internal carotid reflux, it was decided not to use a temporary vascular shunt. Endarterectomy and arteriorrhaphy with a bovine pericardium patch were performed. Although carotid web can be seen with imaging exams, detection can be challenging and it can mimic other conditions, such as arterial dissection, non-calcified atherosclerotic plaque, and intraluminal thrombus. The ease with which it can go unnoticed or misdiagnosed highlights the need to understand this disease.

Keywords

carotid artery diseases; ischemic stroke; carotid endarterectomy

References

1 Mac Grory B, Emmer BJ, Roosendaal SD, Zagzag D, Yaghi S, Nossek E. Carotid web: an occult mechanism of embolic stroke. J Neurol Neurosurg Psychiatry. 2020;91(12):1283-9. http://doi.org/10.1136/jnnp-2020-323938. PMid:33004431.

2 Compagne KCJ, van Es ACGM, Berkhemer OA, et al. Prevalence of carotid web in patients with acute intracranial stroke due to intracranial large vessel occlusion. Radiology. 2018;286(3):1000-7. http://doi.org/10.1148/radiol.2017170094. PMid:29040040.

3 Kim SJ, Nogueira RG, Haussen DC. Current understanding and gaps in research of carotid webs in ischemic strokes. JAMA Neurol. 2019;76(3):355-61. http://doi.org/10.1001/jamaneurol.2018.3366. PMid:30398546.

4 Zhang AJ, Dhruv P, Choi P, et al. A systematic literature review of patients with carotid web and acute ischemic stroke. Stroke. 2018;49(12):2872-6. http://doi.org/10.1161/STROKEAHA.118.021907. PMid:30571430.

5 Guglielmi V, Compagne KCJ, Sarrami AH, et al. Assessment of recurrent stroke risk in patients with a carotid web. JAMA Neurol. 2021;78(7):826-33. http://doi.org/10.1001/jamaneurol.2021.1101. PMid:33970205.

6 Compagne KCJ, Dilba K, Postema EJ, et al. Flow patterns in carotid webs: a patient-based computational fluid dynamics study. AJNR Am J Neuroradiol. 2019;40(4):703-8. http://doi.org/10.3174/ajnr.A6012. PMid:30872422.

7 Zhang H, Niu L, Zhang F, Luo X, Feng Y, Zhang C. Ultrasound-guided retrograde infrapopliteal artery access for recanalization of complex femoral-popliteal artery occlusions. Ann Vasc Surg. 2021;76:357-62. http://doi.org/10.1016/j.avsg.2021.03.042. PMid:33910048.

8 Hu H, Zhang X, Zhao J, Li Y, Zhao Y. Transient ischemic attack and carotid web. AJNR Am J Neuroradiol. 2019;40(2):313-8. http://doi.org/10.3174/ajnr.A5946. PMid:30655258.

9 Patel SD, Otite FO, Topiwala K, et al. Interventional compared with medical management of symptomatic carotid web: A systematic review. J Stroke Cerebrovasc Dis. 2022;31(10):106682. http://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106682. PMid:35998383.

10 Haussen DC, Grossberg JA, Bouslama M, et al. Carotid Web (Intimal Fibromuscular Dysplasia) has high stroke recurrence risk and is amenable to stenting. Stroke. 2017;48(11):3134-7. http://doi.org/10.1161/STROKEAHA.117.019020. PMid:29018133.

11 Sajedi PI, Gonzalez JN, Cronin CA, et al. Carotid bulb webs as a cause of “cryptogenic” ischemic stroke. AJNR Am J Neuroradiol. 2017;38(7):1399-404. http://doi.org/10.3174/ajnr.A5208. PMid:28495950.

12 Zhang J, Yan Y, Yao W, Liu J, Cui L. Multimodality imaging of carotid web: a case report and literature review. Vascular. 2023;31(4):699-707. http://doi.org/10.1177/17085381221084809. PMid:35306924.
 


Submitted date:
09/29/2024

Accepted date:
12/06/2024

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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