目的:颈动脉网是隐源性卒中的潜在机制。它很容易逃避诊断或被误诊,因为它很少引起血流动力学狭窄。目前,对患病率缺乏共识,病因学,成像评估,颈动脉的治疗策略。我们旨在介绍颈动脉网的多模态成像,并全面回顾颈动脉网的特征。
方法:一名38岁男性颈动脉网,他患有急性左半球综合征,在初始报告中没有通过计算机断层扫描血管造影和高分辨率磁共振成像识别,但在回顾中被发现,然后通过数字减影血管造影和组织病理学证实。对颈动脉网进行了文献综述,以确定患病率,自然历史,成像工具,颈动脉网的优化管理。
结果:80例报告,包括681例颈动脉网患者。短暂性脑缺血发作/卒中患者的症状性颈动脉网患病率为1.2%,6.4%的隐源性缺血性卒中患者,大血管闭塞卒中患者占1.1%,接受颈动脉狭窄手术的患者为4.4%。共有23.0%的患者有双侧颈动脉网。在大多数患者中,颈动脉网位于颈动脉(98.7%)的后壁(87.3%)。平均长度为3.3mm,平均狭窄率为20.9%。共有31.6%的患者存在颈动脉网中的血栓,75.9%的患者存在大血管闭塞。CT血管造影和数字减影血管造影是检测颈动脉网的有利工具。颈动脉血运重建患者有罕见的围手术期并发症,没有复发性中风。
结论:颈动脉网是缺血性卒中的公认原因。很容易被漏诊或误诊。颈动脉血管重建术可有效预防症状性颈动脉网患者的卒中复发。临床医生应加强对颈动脉网的学习和理解。
OBJECTIVE: The carotid web is a compelling potential mechanism of cryptogenic stroke. It is easy for it to escape diagnosis or be misdiagnosed, since it rarely causes hemodynamic stenosis. Currently, there is a lack of consensus on the prevalence, etiology, imaging evaluation, and treatment strategy of carotid artery. We aimed to present the multimodal imaging of carotid web and comprehensively review the characteristics of carotid web.
METHODS: A 38 year-old man with carotid web, who presented with acute left hemispheric syndrome, was not identified by computed tomography angiography and high-resolution magnetic resonance imaging in the initial report, but were identified in retrospect and then confirmed by digital subtraction angiography and histopathology. A literature review of carotid web was performed to identify prevalence, nature history, imaging tools, and optimal management of carotid web.
RESULTS: 80
reports including 681 patients with carotid web were identified. The prevalence of symptomatic carotid web was 1.2% in patients with transient ischemic attack/stroke, 6.4% in patients with cryptogenic ischemic stroke, 1.1% in patients with large vessel occlusion stroke, and 4.4% in patients who operated on for carotid stenosis. A total of 23.0% patients had bilateral carotid web. In most patients, carotid web was located on the posterior wall (87.3%) of the carotid artery (98.7%). The mean length was 3.3 mm and mean stenosis rate was 20.9%. A total of 31.6% percent patients had thrombus trapped in carotid web and 75.9% patients had large vessel occlusion. Computed tomography angiography and digital subtraction angiography were favorable tools to detect carotid web. There were rare periprocedural complications and no recurrent strokes in carotid revascularization patients.
CONCLUSIONS: carotid web is an under-recognized cause of ischemic stroke. It is easy to be missed or misdiagnosed. Carotid revascularization can effectively prevent recurrent stroke for patients with symptomatic carotid web. Clinicians should strength their learning and understanding of carotid web.