Acidente vascular cerebral isquêmico secundário a Carotid Web: Relato de Caso

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Background: The carotid web is a rare type of myofibrous dysplasia which is receiving increased attention for being a risk factor of ischemic stroke. It is a rare carotid artery disease, and its incidence is about 0,62%. The carotid web presents as a membrane located inside the arterial lumen, protruding from the posterior wall of the carotid sinus or the starting portion of the internal carotid artery. In some cases, thrombus can be seen on the carotid web. This occurs due to blood stasis and platelet activation, resulting in thrombosis which can embolize intracranially. Case presentation: 40 years-old female presents with transient left paresthesia and paresis, lasting 60 minutes. Weeks after, she presented a stronger and transient event, associated with dysarthria and rhyme deviation. Magnetic resonance investigation showed ischemic stroke in the middle cerebral artery area and thrombus in the right internal carotid artery, and angiography evidenced the presence of a probable atherosclerotic plaque in the right carotid sinus, attached to a fresh thrombus. She started anticoagulation therapy. In control exam, the arterial area in the right carotid sinus was identified without the presence of thrombus, allowing a better characterization of a membrane attached to the posterior wall of the internal carotid artery, coming up with features compatible with carotid web. Due to the recurrence of neurological deficits, besides being transitory, it was opted for endovascular treatment, aiming to avoid the evolution of a transient neurological deficit to a permanent one. She was submitted to angioplasty and maintained on double antiagregation due to stent and, until the moment, did not present any new neurovascular events. Conclusion: The relevancy of this report is due to carotid web being an under-recognized cause of cryptogenic stroke that should always be suspected when there is recurrent infarction in the territory of one internal carotid artery.