Neurology Publish Ahead of PrintDOI: 10.1212/WNL.0000000000010972

Acute thrombosis on a carotid web associated with an ipsilateral embolic stroke Authors: 1. Mohammed Wadhah Al-Dulaimi, MD Affiliation: Tufts Medical Center Address: 800 Washington St, Biewend 12 Boston, MA 02111 2. Mohamed Ridha, MD Affiliation: Tufts Medical Center Address: 800 Washington St, Biewend 12 Boston, MA 02111 3. Juan E. Small, MD Affiliation: Lahey Hospital and Medical Center Address: 41 Burlington Mall Road, Burlington, MA 01805 4. Mathew Tilem, MD Affiliation: Lahey Hospital and Medical Center Address: 41 Burlington Mall Road, Burlington, MA 01805 Neurology® Published Ahead of Print articles have been peer reviewed and accepted for

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Published Ahead of Print on October 1, 2020 as 10.1212/WNL.0000000000010972

5. Barbara Voetsch, MD, PhD Affiliation: Lahey Hospital and Medical Center Address: 41 Burlington Mall Road, Burlington, MA 01805 6. Johanna Helenius, MD, PhD Affiliation: Lahey Hospital and Medical Center Address: 41 Burlington Mall Road, Burlington, MA 01805

Corresponding author: Mohammed Wadhah Al-Dulaimi (maldulaimi@tuftsmedicalcenter.org) Search terms: Carotid web, Other cerebrovascular disease/ Stroke, Embolism, CT Publication History: This manuscript has not been previously published Submission type: Neuroimages Title character count: 79 Number of Figures: 1 Word Count of Paper: 100

Study funding: No targeted funding reported.

Disclosures This study received no outside funding or sponsorship. Mohammed Wadhah Al-Dulaimi- Reports no disclosures Mohamed Ridha- Reports no disclosures Juan E. Small, MD- Reports no disclosures Mathew Tilem, MD- Reports no disclosures Barbara Voetsch, MD, PhD- Reports no disclosures Johanna Helenius, MD, PhD- Reports no disclosures

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A 56-year-old man without cardiovascular risk factors presented with an acute right MCA stroke (Image-A) treated by intravenous-tPA and endovascular thrombectomy. CT angiogram (CTA) showed a triangular filling defect along the postero-medial margin of the proximal right ICA consistent with a carotid web (CaW), without atherosclerosis (Image-B). Follow-up CTA within two days revealed evolving in-situ thrombus overlying the CaW (Image-C), after which anticoagulation was started. A CaW is a shelf-like linear filling defect of the ICA bulb thought to represent an intimal variant of fibromuscular dysplasia.1 Hypothetically blood stasis along CaW downstream surface may cause thrombus formation and thromboembolic strokes.2

Appendix 1. Authors

Name Location Contribution

Mohammed Al-Dulaimi, MD Tufts Medical Center, Boston Drafted the manuscript

Mohamed Ridha, MD Tufts Medical Center, Boston Drafted the manuscript

Juan E. Small, MD Lahey Hospital and Medical Center Acquisition and analysis of images

Mathew Tilem, MD Lahey Hospital and Medical Center Provided clinical correlation

Barbara Voetsch, MD, PhD Lahey Hospital and Medical Center Critical revision for intellectual content

Johanna Helenius, MD, PhD Lahey Hospital and Medical Center Study concept, design, and coordination

References 1. Choi PM, Menon BK, Demchuk AM. Carotid web and stroke. Eur J Neurol. 2014; 21:e53. doi: 10.1111/ene.12418. 2. Choi PM, Singh D, Trivedi A, et al. . Carotid webs and recurrent ischemic strokes in the era of CT angiography. AJNR Am J Neuroradiol 2015;36:2134–2139

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Figure 1. CTA at presentation (A) demonstrates a right M1 occlusion (arrowheads). A sagittal CTA at presentation (B) demonstrates a shelf-like filling defect along the posterior ICA bulb consistent with a carotid web (gray arrow). A CTA performed 25 hours later (C) shows new thrombus along the web (white arrows).

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DOI 10.1212/WNL.0000000000010972 published online October 1, 2020Neurology 

Mohammed Wadhah Al-Dulaimi, Mohamed Ridha, Juan E. Small, et al. Acute thrombosis on a carotid web associated with an ipsilateral embolic stroke

This information is current as of October 1, 2020

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