Carotid artery stenting for a carotid web revealed by shape change after adherent thrombus resolution following conservative treatment.

Abstract

Background: The carotid web (CW) is a shelf-like defect located on the posterior wall at the origin of the internal carotid artery. Abnormal blood flow in the CW causes thrombus formation, making it difficult to diagnose. Some reports have indicated that CWs become detectable only after thrombus resolution. We report a case of a patient who underwent carotid artery stenting (CAS) for a previously undetected CW with the resolution of an adherent thrombus resulting in a favorable outcome.

Case description: A 39-year-old male presented with the left hemiparesis rushed to our hospital. Magnetic resonance imaging and angiography revealed a cerebral infarction caused by occlusion of the right middle cerebral artery. Initial cerebral angiography showed a mobile contrast defect in the posterior wall of the right cervical internal carotid artery. The patient was treated conservatively with medical therapy and rehabilitation. Follow-up angiography 1 month later revealed a shelf-like defect at the posterior wall of the origin of the internal carotid artery, which was different from the initial cerebral angiography. CAS was performed for the CW with a resolution of the adherent thrombus.

Conclusion: A CW may present with varying imaging findings depending on the nature of the adherent thrombus. In cases where such adherent thrombus hamper diagnosis or in the absence of adherent thrombus, the imaging finding of the pooling of the blood flow may help in diagnosing a CW.