A cause of recurrent strokes: carotid webs detected by CT angiogram.

Hannah Smyth,Sean Murphy,Derek Hayden,Eoin Kavanagh,Danielle Byrne

doi:10.1259/bjrcr.20170066

Abstract

Carotid webs are an uncommon cause of recurrent ischaemic strokes. They are considered a form of fibromuscular dysplasia, possibly developmental in origin, with non-inflammatory and non-atherosclerotic features and a characteristic appearance on CT angiography. They have been described as a thin intraluminal filling defect along the posterior wall of the carotid bulb in oblique sagittal reformats and a septum on axial CT angiography. Here we summarize two cases of ischaemic strokes secondary to carotid webs with characteristic images. Detection and awareness of carotid webs and their imaging features among radiologists and physicians are important as it is associated with a high risk of recurrent cerebrovascular events.

Highlights

CASE 1 An 85-year-old right-handed male presented with sudden onset right hemiparesis
Figure 1. 85-year-old male patient who presented with acute right-sided weakness. (a) Sagittal, (b) axial and (c) coronal CT angiogram (CTA) images demonstrate a carotid web arising from the posterior wall of the proximal left internal carotid artery (ICA)
He was started on dabigatran 150 mg twice daily and aspirin 75 mg. He has been transferred to a stroke rehabilitation centre with residual speech apraxia, improving right limb weakness and ability to comprehend one step commands. These cases describe two males who presented with ischaemic strokes due to carotid webs

Summary

Introduction

CASE 1 An 85-year-old right-handed male presented with sudden onset right hemiparesis. CT angiogram (CTA) demonstrated a left internal carotid artery (ICA) web (Figure 1).

Results

Conclusion