Acute carotid web thrombosis and early reocclusion after successful thrombectomy: a case report
Notice bibliographique
Résumé
Case presentation: A 58-year-old Black woman presented with sudden onset aphasia, right-sided weakness, and numbness 11 hours prior to admission at the Emergency Unit. On examination, her NIHSS score was 13, indicating a left middle cerebral artery (MCA) stroke. She had a history of smoking but no other cardiovascular diseases. CT revealed loss of gray-white differentiation in the left insular and frontal regions, with an Alberta Stroke Program Early CT Score (ASPECTS) of 8. CT angiogram of the head showed a left MCA occlusion and a small wedge-shaped hypodense filling defect along the posterior margin of the left internal carotid artery (ICA), suggestive of a carotid web (CW). Thrombolytic therapy was not administered. Endovascular mechanical thrombectomy (MT) using combined use of contact aspiration and stent-retriever technique was performed, achieving successful recanalization (TICI score 3) within 124 minutes Door-to-Recanalization time. The NIHSS score after the procedure was 17. Blood tests, transthoracic echocardiography, continuous ECG monitoring and evaluation for hypercoagulability testing and vasculitis was performed to investigate the etiolgy. Subsequent CT at 24 hours showed hypodensity in the left deep nuclei and left frontoparietal areas and left hyperdense MCA sign. Carotid doppler ultrasound (CDUS) revealed a hypoechoic mass, suggestive of acute thrombus formation on the CW. Cerebral angiography performed prior to carotid angioplasty, identified reocclusion of the ipsilateral MCA. Due to the risk of hemorrhagic complications, a second MT was not performed. The patient was treated with aspirin 300 mg and clopidogrel 75 mg, followed by angioplasty with stent placement 10 days post-stroke. She was subsequently transferred to a stroke rehabilitation center, the NIHSS score was 14 and the RANKIN score was 4. Discussion: Carotid web is a recognized cause of cryptogenic stroke. Our findings are consistent with previous studies describing a higher prevalence of CW in young Black female patients, often ipsilateral to ischemic strokes of undetermined cause. Symptomatic CW is associated with a high rate of recurrent stroke (17% to 40%), particularly in cases involving morphological and hemodynamic changes such as local flow turbulence or in situ thrombus formation. Acute CW thrombosis and early reocclusion following successful MT are rarely reported. Early neurological deterioration (within 3 days) and hemodynamic disturbances related to CW are important red flags in these cases. Follow-up with CDUS may be useful for monitoring thrombus formation. Carotid stenting immediately after MT could be considered to prevent recurrent strokes given the elevated short-term risk post-MT. Final comments: The optimal management to prevent recurrent stroke in patients with carotid web remains uncertain. Observational studies generally favor interventional therapy over medical management, but randomized trials are needed to provide more definitive guidance.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».