Recurrent thrombus formation in a carotid web: highlighting the importance of timely surgical intervention. Illustrative case.

Toshihide Takahashi, Kiyoyuki Yanaka, Minami Saura, Hitoshi Aiyama, Nobuyuki Takahashi, Aiki Marushima, Yuji Matsumaru, Eiichi Ishikawa
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Abstract

Background: Carotid webs are rare nonatherosclerotic disorders in the carotid artery and are increasingly recognized as factors of ischemic stroke in the young population. Asymptomatic webs can be treated with antithrombotic therapy, whereas symptomatic cases frequently require surgical interventions, including carotid endarterectomy (CEA). However, guidelines for the optimal timing of these treatments remain unestablished, especially compared to atherosclerotic stenotic lesions, due to the rarity of carotid webs.

Observations: A 50-year-old female patient had a carotid web-induced left hemispheric ischemic stroke. Mechanical thrombectomy successfully restored blood flow, but a thrombus reformed in the carotid web within 1 month following the procedure. This caused early CEA, during which the carotid web and thrombus were removed. This case highlights rapid thrombus reformation, indicating that some carotid webs can be more unstable than previously thought.

Lessons: This case emphasizes the importance of timely surgical intervention in symptomatic carotid webs to prevent recurrent strokes. Additionally, antithrombotic therapy can manage asymptomatic webs, but surgical treatment may be required in unstable cases. Thus, further studies are warranted to establish standardized treatment guidelines for carotid webs. https://thejns.org/doi/10.3171/CASE24682.

颈动脉网复发性血栓形成:强调及时手术干预的重要性。说明情况。
背景:颈动脉网是颈动脉中罕见的非动脉粥样硬化性疾病,并且越来越多地被认为是年轻人群缺血性卒中的因素。无症状的血网可以用抗血栓疗法治疗,而有症状的病例通常需要手术干预,包括颈动脉内膜切除术(CEA)。然而,由于颈动脉网的罕见性,这些治疗的最佳时机的指南仍未建立,特别是与动脉粥样硬化性狭窄病变相比。观察:一位50岁的女性患者有颈动脉网引起的左半球缺血性中风。机械取栓成功地恢复了血流,但术后1个月内颈动脉网内出现血栓。这导致早期CEA,在此期间颈动脉网和血栓被清除。这个病例突出了血栓的快速重建,表明一些颈动脉网可能比以前认为的更不稳定。经验教训:本病例强调了及时手术干预症状性颈动脉网的重要性,以防止卒中复发。此外,抗血栓治疗可以管理无症状的网,但手术治疗可能需要在不稳定的情况下。因此,需要进一步的研究来建立颈动脉网的标准化治疗指南。https://thejns.org/doi/10.3171/CASE24682。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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