A RARE CASE OF CAROTID WEB IN YOUNG MAN WITH ISCHEMIC STROKE

Background and Aims: CarotidWeb (CW) is a rare cause of Ischemic Stroke (IS) in young people. It is a nonatheroscherotic alteration of carotid artery (CA), identified radiographically as a shelf-like intraluminal filling defect on the posterolateral wall of proximal internal carotid artery (ICA). CW etiology is unknown. Methods: We report a case of a young man with left CW and IS on ipsilateral Middle Cerebral Artery (MCA) territory. Results: A 49-years-old man was admitted to the emergency department (ED) 45 minutes after sudden onset of right hemiparesis and aphasia (NIHSS 9). He had no previous pathology and did not use medical treatment. CT perfusion showed hypoperfusion on the left temporoparietal lobe and a steno-occlusion of distal M1 segment of left MCA. According to Guidelines we started intravenous thrombolysis (IV) 90 minutes after symptoms onset, followed by catheter-based cerebral thrombectomy 20 minutes later with improvement of neurological status (NIHSS=4). Cerebral Angiography showed a shelf-like intraluminal filling defect along the posterior wall of left proximal ICA with classical stasis of intravenous contrast distal to the CW. We decided to perform endovascular stenting of CW 5 days later, followed by dual antiplatelet therapy. Workup for hypercoagulability and vasculitis was normal. Renal Doppler Ultrasound was negative. MRI showed small left parietal ischemic lesion. Patient was discharged a week after stroke onset (NIHSS=0).