Carotid web: Pathophysiology, diagnostic, and therapeutic options. A narrative review.

Autor:	Rivoire E; Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France.; Université Claude Bernard Lyon 1, Laboratoire Inter Universitaire de la Biologie et de la Motricité, UR7424, Equipe Athérosclérose Thrombose et Activité Physique, Lyon, France., Della Schiava N; Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France.; Institut National des Sciences Appliquées, Laboratoire de Génie Electrique et Ferroélectriqué, EA 682, Lyon, France., Rouvière O; Service d'Imagerie Urinaire et Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.; Université Claude Bernard Lyon 1, LabTau, INSERM U1052, Lyon, France., Pagnoux G; Service d'Imagerie Urinaire et Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France., Cho TH; Neurovascular Unit, Hospices Civils de Lyon, Lyon, France.; CarMeN Laboratory, Institut National de la Santé et de la Recherche Médicale U1060, Claude Bernard Lyon I University, Bron, France., Millon A; Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France.; Université Claude Bernard Lyon 1, Laboratoire Inter Universitaire de la Biologie et de la Motricité, UR7424, Equipe Athérosclérose Thrombose et Activité Physique, Lyon, France., Long A; Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France.; Université Claude Bernard Lyon 1, Laboratoire Inter Universitaire de la Biologie et de la Motricité, UR7424, Equipe Athérosclérose Thrombose et Activité Physique, Lyon, France.; Service de Médecine Interne et de Médecine Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
Jazyk:	angličtina
Zdroj:	Vascular medicine (London, England) [Vasc Med] 2024 Oct 13, pp. 1358863X241282635. Date of Electronic Publication: 2024 Oct 13.
DOI:	10.1177/1358863X241282635
Abstrakt:	A carotid web (CaWeb), otherwise known as a carotid bulb diaphragm, is a spur of intimal fibrous tissue extending into the carotid bulb. It is a rare, underdiagnosed cause of ischemic strokes in young people. The purpose of this narrative review was to provide an update on CaWebs, highlighting recent evolutions in their management. We undertook a comprehensive literature search on main electronic databases - MEDLINE/PubMed, Cochrane Library, Web of Science, and EMBASE - using a dedicated equation to include studies up to February 13, 2024. We also searched for the most recent guidelines about carotid disease or stroke including CaWeb management. A CaWeb is found in up to 10% of young patients, particularly young women, with severe anterior stroke due to an arterial-arterial embolism from the intra-nidus thrombus. Most patients with a CaWeb have less than 50% stenosis on duplex ultrasound, and diagnosis is mostly obtained by computed tomography angiography. When applying traditional stenosis criteria for symptomatic disease (> 50% stenosis), this highly morbid condition is easily overlooked, leading to recurrent strokes. Antithrombotic treatment is associated with a high recurrence rate of stroke after the index event. The first-line treatment of symptomatic CaWebs is increasingly based on endarterectomy or stenting. The lack of recommendations before 2021 and recent discordant guidelines make CaWeb management complex. No guidelines are available to manage patients with asymptomatic CaWebs. Results from ongoing multicenter registries will be useful in guiding management decisions. Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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