Acute carotid web thrombosis and early reocclusion after successful thrombectomy: a case report
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".