Carotid Web Research Articles

Abstract TP126: Carotid Webs in Cryptogenic Ischemic Strokes

Introduction: Carotid web is an intraluminal projection in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. It may serve as a source of thrombus formation leading to embolic strokes and has been poorly described. We aim to study the prevalence of carotid webs among patients with cryptogenic ischemic strokes (CIS). Methods: This was a retrospective analysis of patients aged 18-60 years who presented to two comprehensive stroke centers with CIS (TOAST criteria) and underwent neck CTA, from January 2016 to May 2017. Carotid web was defined as a shelf-like projection with linear/smooth filling on the posterior bulb without superimposed atherosclerosis (defined as adjacent calcifications or wall thickness >3mm). CTAs were reviewed by a neurointerventionist blinded to clinical and other radiological studies. CIS patients with carotid webs (with strokes within the vascular territory) were then compared to the remaining CIS patients. Results: Of 162 CIS patients within the study period, 43 patients met the inclusion criteria. Thirteen patients had carotid webs (29.5%), 10 of whom had a stroke in the same vascular territory as the web (22.7%). Median length of the intraluminal web projection was 1.6[1.5-2.0]mm. Age, gender and comorbidities were similar between the patients with stroke within the carotid web territory (n=10) and the remainder of the CIS patients (n=33)( Table ). None of the patients with ischemic stroke in the carotid web territory were white, while 90% were black (compared to 18% and 74% of the 43 CIS patients, respectively). The NIHSS in the carotid web group was 14.2 [7.9-20.5] as compared to the other CIS arm 10.1 [3.3-16.9]; p=0.09. Conclusion: Carotid webs are an under-recognized etiology in CIS affecting the young. Routine and careful vascular imaging analysis of the carotid bulb in young CIS patients is indicated. Further studies are needed.

Abstract TP128: Multicenter Experience With Stenting for Carotid Webs

Background: Carotid web is a shelf-like lesion in the posterior aspect of the internal carotid bulb and represents an intimal variant of fibromuscular dysplasia. Carotid webs have been associated with recurrent strokes and traditionally treated with surgical excision. We report a multicenter experience of stenting in patients with symptomatic carotid webs. Methods: Retrospective review of patients admitted to three comprehensive stroke centers identified to have a carotid web with otherwise negative stroke workup that underwent stenting. A carotid web was defined by the presence of a shelf-like/linear, smooth filling defect in the posterior aspect of the carotid bulb diagnosed by neck CT/MR angiography and confirmed with conventional angiography. Results: Twenty patients with symptomatic (80% Stroke/20% TIA) carotid webs were stented. Median age was 48[41-61] years, 7(35%) were male, and 15(75%) Black. Median NIHSS was 11[2-16] while ASPECTS 8[7-8]. Eight (40%) received intravenous thrombolysis and 10 (50%) thrombectomy. All patients were stented on dual antiplatelets (aspirin and clopidogrel[17] or ticagrelor[3]) at a median 9[4-30]days after the last vascular event. Closed-cell stents were used in 75% of cases (XACT [14] and Wallstent [1]) while open-cell stents in 25% (Acculink[5]). No cases required angioplasty for residual stenosis had to be performed. DIstal embolic protection was used in 19 cases (SpiderFX[18] and Emboshield_NAV6[1]) while proximal protection in 1 (MoMa). No periprocedural events occurred with the exception of two cases of hypotension/bradycardia (one requiring 24-hour vasopressors). No parenchymal hematomas were observed but one patient developed vaginal hemorrhage requiring discontinuation of one antiplatelet at 2 months. Modified Rankin Scale 0-2 (independence) at 90 days was recorded in 95% of patients. Clinical follow-up post stent occurred for a median of 4 [2-12] months and no follow-up cerebrovascular events were noted. Follow-up vascular imaging was performed in 95% patients at a median of 3[2-12]months and were all unremarkable. Conclusions: Stenting for symptomatic carotid web appears to be a valid, safe, and effective alternative to surgical piecemeal resection. Further studies are warranted.

Abstract WP122: A Serial Study of Carotid Web

Introduction: Intimal flap-like protrusion of the carotid artery is referred to as a carotid web (also known as carotid diaphragm and atypical fibromuscular dysplasia) that can cause recurrent ischemic stroke. We retrospectively studied the prevalence, demographics, clinical presentation, and imaging features of all patients in a series with defined carotid webs, and describe the treatment and histopathology of two that were symptomatic. Methods: This retrospective study analyzed data from a series of 505 patients who underwent head and neck computed tomography angiography (CTA) at Kyoto University Hospital between April 2011 and Oct 2016. Reports have indicated that CTA is reliable for detecting carotid webs, which are defined on images of oblique sagittal sections as a thin intraluminal filling defect along the posterior wall of the carotid bulb. Ultrasonic echo and MRI findings were also matched when available. Carotid webs were finally defined by interpretation of CTA images by a radiologist and an experienced neurosurgeon. Results: The prevalence of carotid webs in this series was 1.8% (9 of 505 patients), the mean age was 56 (range, 42 - 67) years, and six patients were women. Two (22.2%) of the nine patients with carotid webs had recurrent stroke and both were treated radically by carotid endarterectomy. The histopathological findings suggested fibromuscular dysplasia accompanied by early atherosclerotic changes. Conclusions: The prevalence of carotid webs was low and they tended to occur more frequently among women in the present series. An optimal management strategy has not yet been devised. However, recurrent ischemic stroke might be caused by turbulent blood flow at the point of recess that leads to the formation of thrombus and emboli. We recommend that such patients undergo radical treatment.

Carotid Webs: Radiographic Appearance and Significance.

First identified and named in 1973, carotid webs are nonatherosclerotic fibrous bands that arise along the posterior margin of the carotid bulb.[1][1],[2][2] Histopathologically, these entities are characterized by fibroelastic thickening of the arterial intima. They appear on imaging modalities as

Prevalence of Carotid Web in Patients with Acute Intracranial Stroke Due to Intracranial Large Vessel Occlusion.

Purpose To investigate the prevalence of symptomatic carotid web in patients with acute ischemic stroke due to intracranial large vessel occlusion, to determine the clinical and imaging profile of patients with carotid web as well as their association with ischemic stroke, and to determine the interobserver agreement in the assessment of carotid webs. Materials and Methods All patients (n = 500) of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) in whom the carotid bifurcation could be assessed (n = 443) were included. The presence of a carotid web at the carotid bifurcations was evaluated at computed tomographic (CT) angiography. Demographics, clinical characteristics, and imaging baseline characteristics were presented by descriptive statistics for patients with an identified carotid web. Interobserver agreement in the detection of carotid webs was examined by using kappa statistics. Results Eleven (2.5%) carotid webs were found at the symptomatic side and two (0.5%) carotid webs were found at the asymptomatic side. Ten (91%) patients with a symptomatic carotid web were female. Nine patients with a symptomatic carotid web did not have major risk factors or other causes for ischemic stroke (82%). Fair to good interobserver agreement (κ, 0.72) was observed for diagnosing carotid webs at CT angiography. Conclusion Carotid webs at the symptomatic carotid bifurcation were observed in 2.5% of the patients with acute ischemic stroke due to large vessel occlusion and were mostly diagnosed in female patients with a fair to good interobserver agreement. © RSNA, 2017 Clinical trial registration nos. NTR1804 and ISRCTN10888758 Online supplemental material is available for this article.

Carotid Web (Intimal Fibromuscular Dysplasia) Has High Stroke Recurrence Risk and Is Amenable to Stenting

Carotid webs have been increasingly recognized as a cause of recurrent stroke, but evidence remains scarce. We aim to report the clinical outcomes and first series of carotid stenting in a cohort of patients with strokes from symptomatic carotid webs. Prospective and consecutive data of patients <65 years old with cryptogenic stroke admitted within September 2014 to May 2017. Carotid web was defined by a shelf-like/linear filling defect in the posterior internal carotid artery bulb by computed tomographic angiography. Twenty-four patients were identified (91.6% strokes/8.4% transient ischemic attacks [TIAs]). Median age was 46 (41-59) years, 61% were female, and 75% were black. Median National Institutes of Health Stroke Scale score was 10.5 (3.0-16.0) and ASPECTS (Alberta Stroke Program Early CT Score) was 8 (7-8). There were no parenchymal hemorrhages, and 96% of patients were independent at 3 months. All webs caused <50% stenosis. In patients with bilateral webs (58%), median ipsilateral web length was larger than contralateral (3.1 [3.0-4.5] mm versus 2.6 [1.85-2.9] mm; P=0.01), respectively. Twenty-nine percent of patients had thrombus superimposed on the symptomatic carotid web. A recurrent stroke/TIA involving the territory of the previously symptomatic web occurred in 7 (32%; 6 strokes/1 TIA) patients: 3 <1 week, 2 <first year, and 3 >1 year of follow-up. Two recurrences occurred on dual antiplatelet therapy, 3 on antiplatelet monotherapy, 1 within 24 hours of thrombolysis, and 1 off antithrombotics. Median follow-up was 12.2 (8.0-18.0) months. Sixteen (66%) patients were stented at a median 12.2 (7.0-18.7) days after stroke with no periprocedural complications. No recurrent strokes/TIAs occurred in stented individuals (median follow-up of 4 [2.4-12.0] months). Carotid web is associated with high recurrent stroke/TIA risk, despite antithrombotic use, and is amenable to carotid stenting.

Carotid Bulb Webs as a Cause of "Cryptogenic" Ischemic Stroke.

Carotid webs are intraluminal shelf-like filling defects at the carotid bulb with recently recognized implications in patients with recurrent ischemic stroke. We sought to determine whether carotid webs are an under-recognized cause of "cryptogenic" ischemic stroke and to estimate their prevalence in the general population. A retrospective review of neck CTA studies in young patients with cryptogenic stroke over the past 6 years (n = 33) was performed to determine the prevalence of carotid webs compared with a control group of patients who received neck CTA studies for reasons other than ischemic stroke (n = 63). The prevalence of carotid webs in the cryptogenic stroke population was 21.2% (95% CI, 8.9%-38.9%). Patients with symptomatic carotid webs had a mean age of 38.9 years (range, 30-48 years) and were mostly African American (86%) and women (86%). In contrast, only 1.6% (95% CI, 0%-8.5%) of patients in the control group demonstrated a web. Our findings demonstrate a statistically significant association between carotid webs and ischemic stroke (OR = 16.7; 95% CI, 2.78-320.3; P = .01). Carotid webs exhibit a strong association with ischemic stroke, and their presence should be suspected in patients lacking other risk factors, particularly African American women.

A Systematic Literature Review of Patients with Carotid Web and Acute Ischemic Stroke. (P5.286)

A Systematic Literature Review of Patients with Carotid Web and Acute Ischemic Stroke. (P5.286)

MR imaging of carotid webs.

We propose a magnetic resonance (MR) imaging protocol for the characterization of carotid web morphology, composition, and vessel wall dynamics. The purpose of this case series was to determine the feasibility of imaging carotid webs with MR imaging. Five patients diagnosed with carotid web on CT angiography were recruited to undergo a 30-min MR imaging session. MR angiography (MRA) images of the carotid artery bifurcation were acquired. Multi-contrast fast spin echo (FSE) images were acquired axially about the level of the carotid web. Two types of cardiac phase resolved sequences (cineFSE and cine phase contrast) were acquired to visualize the elasticity of the vessel wall affected by the web. Carotid webs were identified on MRA in 5/5 (100%) patients. Multi-contrast FSE revealed vessel wall thickening and cineFSE demonstrated regional changes in distensibility surrounding the webs in these patients. Our MR imaging protocol enables an in-depth evaluation of patients with carotid webs: morphology (by MRA), composition (by multi-contrast FSE), and wall dynamics (by cineFSE).

Abstract 207: A Systematic Literature Review of Patients with Carotid Web and Acute Ischemic Stroke

Introduction: Carotid Web (CW) is a rare form of focal fibromuscular dysplasia that results in an abnormal shelf-like projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. There is uncertainty in diagnosis, prognosis, and optimal management of this uncommon entity. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods: Our literature search for CW and related terms yielded 1017 results. After a preliminary assessment of all 1017 retrieved manuscripts; 72 manuscripts were reviewed in detail. A total of 31 manuscripts met entry criteria and were included in our SLR. We present the demographics, cardiovascular (CV) risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality of CW patients. Results: Our SLR resulted in 104 patients with CW, (median age at presentation: 45.7 [IQR 45-57], 52.3% female). The majority (68.3%) of CW patients did not have CV risk factors, however, 22.2% of patients were smokers. 47.8% of patients suffered recurrent stroke. The majority of patients were ultimately treated with antiplatelet therapy (94.4%) and 21.2% underwent carotid revascularization (4.8% carotid stenting, 16.3% carotid endarterectomy). None of the patients who underwent revascularization had a reported stroke recurrence. See Table. Conclusions: CW is a rare disease leading to ischemic stroke in younger patients without typical CV risk factors. CW patients in our SLR were at extremely high risk for recurrent stroke (47.8%). Aggressive secondary stroke prevention measures are indicated in this patient population, however, the optimal treatment strategies remain unclear. Carotid revascularization may be the definitive treatment for certain patients with CW, but further studies are needed as incomplete reporting and potential publication bias limit our findings.

Abstract TMP37: Prevalence of Carotid Webs in Cryptogenic Stroke

Introduction: Carotid Webs (also termed “atypical FMD”) are characterized by a focal, intraluminal filling defect along the posterior wall of the carotid bulb. They have been reported in association with recurrent stroke in young patients without atherosclerotic risk factors and may represent an unrecognized and potentially treatable cause of stroke. Stroke mechanism appears to be related to sluggish blood flow and thrombi formation. The purpose of our study was to determine the prevalence of carotid webs in patients with cryptogenic stroke after standard complete stroke evaluation. Methods: Retrospective analysis of all patients under age 55 presenting with ischemic strokes 9/2009- 8/2015. CTA has been found to be reliable in detecting webs, so was chosen as the modality for interpretation. 119 cryptogenic stroke patients were identified; 41 of these had CTA. De-identified CTAs were evaluated on TerraRecon by two experienced, board certified, fellowship trained neuroradiologists, with disagreement adjudicated by a third neuroradiologist. Readers were blinded to age, gender, and laterality of stroke. Results: Carotid webs were identified in 7 (17%) cases. Presenting stroke was on the same side as the carotid web in all cases. One case had superimposed thrombus, zero had atherosclerosis, and zero had classic features of fibromuscular dysplasia. One patient had recurrent strokes in the territory. Mean age of patients with carotid web was 38.3 years (range 30-41) with 6 (86%) women and 1 (14%) male. Five patients (71%) were African American. Discussion: Carotid webs were identified in a significant portion of strokes previously diagnosed as cryptogenic. More research is needed to determine the natural history and optimal treatment of patients with carotid webs and more detailed carotid evaluation to identify webs should be considered as part of the stroke evaluation.

Carotid artery web and ischemic stroke: A case-control study.

To determine whether there is an association between carotid artery web and ischemic stroke. This was a single-center, age- and sex-matched, case-control study. Cases were consecutive patients with anterior circulation ischemic stroke of undetermined etiology (Trial of Org 10172 in Acute Stroke Treatment [TOAST] classification). Controls were consecutive patients with cerebral aneurysms, arteriovenous malformations, or primary intracerebral hemorrhages. Additional inclusion criteria were age <60 years and CT angiography of the neck. Two neuroradiologists diagnosed webs according to previously published criteria. One neuroradiologist also assessed for nonstenotic atherosclerotic plaque (carotid wall thickness ≥3 mm or intramural calcification). We used conditional logistic regression to estimate the odds ratio between carotid web and ischemic stroke and its 95% confidence interval. Fifty-three of 62 cases (85%) were matched by age (within 1 year) and by sex to 102 controls. There was a carotid web in 4 of 53 cases (9.4%) vs 1 of 102 controls (1.0%, odds ratio = 8.0, 95% confidence interval = 1.2-67, p = 0.032). There was no significant difference in the prevalence of nonstenotic carotid atherosclerotic plaque between the case and control groups. There was agreement on diagnosis of web for 163 of 164 patients (99%) and 7 of 8 webs (88%), and the Cohen κ for interobserver agreement was 0.93. There is an association between carotid artery web and ischemic stroke in patients who lack an alternative cause of stroke. Carotid web may be an underappreciated risk factor for stroke.

Common Carotid Web: A Rare Cause of Stroke

Common Carotid Web: A Rare Cause of Stroke

Carotid Webs and Recurrent Ischemic Strokes in the Era of CT Angiography.

Carotid webs may cause recurrent ischemic stroke. We describe the prevalence, demographics, clinical presentation, imaging features, histopathology, and stroke risk associated with this under-recognized lesion. A carotid web was defined on CTA as a thin intraluminal filling defect along the posterior wall of the carotid bulb just beyond the carotid bifurcation on oblique sagittal section CTA that was seen as a septum on axial CTA. Using a prospective case series from April 2013 to April 2014, we describe the demographics, spectrum of imaging features on CTA, and histopathology of these carotid webs. From a retrospective analysis of patients at our center from May 2012 to April 2013 who had a baseline head and neck CTA followed by a brain MR imaging within 1-2 days of the CTA, we determine the period prevalence of carotid webs and the prevalence of ipsilateral stroke on imaging. In the prospective series, the mean age was 50 years (range, 41-55 years); 5/7 patients were women. Recurrent stroke was seen in 5/7 (71.4%) patients with the carotid web; time to recurrence ranged from 1 to 97 months. Histopathology suggested a high probability of fibromuscular dysplasia. In the retrospective series, carotid webs were seen in 7/576 patients for a hospital-based-period prevalence of 1.2% (95% CI, 0.4%-2.5%). Two of these 7 patients had acute stroke in the vascular territory of the carotid web. A carotid web may contribute to recurrent ischemic stroke in patients with no other determined stroke mechanism. Intimal variant fibromuscular dysplasia is the pathologic diagnosis in most cases. The prevalence of carotid web is low, while the optimal management strategy remains unknown.

Stroke in a Young Woman Caused by Carotid Web (P1.024)

Stroke in a Young Woman Caused by Carotid Web (P1.024)

EXPERTddx: ChestSternEric J., GurneyJud W., WalkerChristopher M., FranquetTomás, KanneJeffrey P., CarrRobert B., ChungJonathan H., VummidiDharshan, and KicskaGregoryPhiladelphia, Pa: Amirsys, 2011. ISBN 978-1-931884-12-9. Hardcover, $299.00; pp 500.

HomeRadiologyVol. 262, No. 1 PreviousNext Reviews and CommentaryFree AccessBook ReviewsEXPERTddx: ChestChristina PresslChristina PresslChristina PresslPublished Online:Jan 1 2012https://doi.org/10.1148/radiol.11114039MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail EXPERTddx: Chest is part of the well-known EXPERTddx comprehensive series of books. The book is targeted to radiologists at every stage of training and is written by nine authors, all with different levels of radiologic training and experience—from residents to professors. This reference work is intended to accompany radiologists in daily clinical practice and in decision making, especially for unusual differential diagnoses. The book is meant to guide the reader from the root problem—that is, either an observed finding or a specific patient complaint—to the possible answers. By offering a list of the most common possibilities of diagnosis, the book assists the reader in arriving at a reasonable conclusion.Organized by anatomic structures, the book is divided into 116 chapters. There are several illustrations for each chapter, and these illustrations are accompanied by a concise collection of differential diagnoses and key features. There are numerous illustrated examples of typical as well as variant cases and key features. Laid out in a two-column style, pages are, at first glance, stuffed with an abundance of information. However, taking a closer look, one will find useful information that is organized in a didactic, informative manner.In summary, this book can help radiologists by offering guidance based on the observed findings to the most likely diagnostic possibilities. EXPERTddx: Chest is a substantial standard reference and is worth the investment as a reference companion for radiologists at every career stage.Reviewed by Christina Pressl, MDArticle HistoryPublished online: Jan 2012Published in print: Jan 2012 FiguresReferencesRelatedDetailsRecommended Articles Toward a More Quantitative and Specific Representation of NormalityRadiology: Artificial Intelligence2021Volume: 3Issue: 2Putting the Pieces Together: Deep Learning for Knee MRI Multitissue Abnormality Detection and Severity GradingRadiology: Artificial Intelligence2021Volume: 3Issue: 3Isophotes, Scale Space, and Invariants in Lung CT for COPD DiagnosisRadiology: Artificial Intelligence2022Volume: 4Issue: 1Comparison of Chest CT Grading Systems in COVID-19 PneumoniaRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 6Radiological Society of North America Chest CT Classification System for Reporting COVID-19 Pneumonia: Interobserver Variability and Correlation with Reverse-Transcription Polymerase Chain ReactionRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 3See More RSNA Education Exhibits Do Not Be Entangled! Carotid Web - Imaging Features of an Uncommon Stroke EtiologyDigital Posters2018Follow the RSNA Experts! Institutional Utilization of the Consensus Statement for Reporting COVID-19 Findings on CT ChestDigital Posters2020Five Stages of Artifacts: Denial, Anger, Bargaining, Depression, and AcceptanceDigital Posters2019 RSNA Case Collection Dynamic MRI findings of COVID-19 pneumoniaRSNA Case Collection2020Round pneumonia RSNA Case Collection2021Septo-optic dysplasiaRSNA Case Collection2020 Vol. 262, No. 1 Metrics Downloaded 1,147 times Altmetric Score

Vascular neck bruit in a teenager

A healthy 16-year-old female presented to our internal medicine clinic with a 6-month history of dizziness and two fainting attacks within the past month. She mentioned feeling a buzzing noise in the left side of her neck, for which she sought medical advice. Physical examination revealed left carotid bruit but was otherwise unremarkable. Lipid profile and hypercoagulable screen revealed normal values. Doppler ultrasound examination (Figure 1) and then MR angiography of the neck vessels (Figure 2) were performed. Figure 1 (a) Axial ultrasound image of the left common carotid artery. (b) Sagittal Doppler ultrasound image of the left common carotid artery. Figure 2 (a) Axial time-of-flight MR angiographic image of the neck vessels. (b) Three-dimensional projection of the vessels in the left side of the neck. How would you describe the findings? What are the diagnosis and associated risks? Is there a differential diagnosis and what would you do next? Doppler ultrasound of the carotid vessels showed normal vessel wall thickness with no atheromatous plaques, but there was a focal concentric narrowing of the lumen of the left common carotid artery (CCA). This was caused by a circumferential band of tissue (Figure 1a) projecting into the lumen and causing more than 70% stenosis; this was consistent with a congenital carotid web. The colour Doppler ultrasound demonstrated high-flow jet and aliasing in the area of highest velocity, with a significant increase in peak systolic velocity (to 410 cm s−1) and end-diastolic velocity (to 215 cm s−1) (Figure 1b). Time-of-flight (Figure 2a) and intravenous contrast-enhanced (Figure 2b) MR angiography of the neck vessels confirmed the ultrasound findings of a focal CCA web, located 4 cm below the bifurcation. The patient was referred for vascular surgery, where an endarterectomy and a saphenous vein patch angioplasty were performed. To the naked eye, the intraoperative appearance of the artery suggested focal dissection (Figure 3). This was supported by the patient's sporting history of several years as a practitioner of karate, with possible exposure to focal trauma. However, the histopathological examination of the endarterectomy specimen revealed that the web was covered with intima and composed of benign fibromyxoid tissue with no evidence of dissection, haemorrhage, inflammation or atherosclerosis. The pathology findings are consistent with a congenital anomaly (web) rather than with a post-traumatic event. Follow-up after 6 months revealed a capacious patch angioplasty with no evidence of renewed stenosis. Figure 3 Intraoperative picture of the left common carotid artery showing a concentric ridge-like lesion in an otherwise smooth internal vessel wall.

線維筋性形成異常症により内頚動脈水かき状狭窄を認めたＴＩＡ症例

線維筋性形成異常症により内頚動脈水かき状狭窄を認めたＴＩＡ症例

Ultrasound case of the day. Internal carotid artery web (atypical fibromuscular dysplasia).

Ultrasound case of the day. Internal carotid artery web (atypical fibromuscular dysplasia).

The Carotid Web: a Developmental Anomaly of the Brachiocephalic System

A case of a congenital carotid web is reported. This lesion is believed to be a very rare anomaly of carotid development. The embryologic development of the brachiocephalic arteries is discussed. Anomalies of the brachiocephalic arteries including anomalies of origin from the aortic arch, atresia, and persistent communications between the carotid and vertebral system are reviewed.