Carotid free-floating thrombus stemming from carotid web: co-occurrence of two rare causes of ischemic stroke

BMC Neurol. 2023 Nov 8;23(1):399. doi: 10.1186/s12883-023-03448-4.

Abstract

Background: Carotid web (CaW) and carotid free-floating thrombus (CFFT) are rare yet critical causes of ischemic stroke in young adults.

Case presentation: A 54-year-old woman presented with a fluctuating right sensory-motor faciobrachial syndrome. A brain MRI scan revealed multiple small recent asynchronous cortico-subcortical ischemic foci in the vascular territory of the left internal carotid artery. A CT angiography identified a CFFT in the left internal carotid artery arising from an underlying CaW. The patient was treated with excellent clinical outcomes with carotid artery stenting and dual antiplatelet therapy.

Conclusions: We provide a structured pathophysiological rationale connecting CaW and CFFT and highlight pivotal therapeutic implications. Further studies are needed to investigate this relationship and guide assessment and treatment.

Keywords: Carotid artery stenting; Cerebrovascular disorder; Etiology; Fibromuscular dysplasia; Ischemic stroke; Young adults.

Publication types

  • Case Reports

MeSH terms

  • Carotid Arteries
  • Carotid Artery, Internal / diagnostic imaging
  • Carotid Artery, Internal / surgery
  • Carotid Stenosis* / complications
  • Female
  • Humans
  • Ischemic Stroke* / complications
  • Middle Aged
  • Stents / adverse effects
  • Stroke* / complications
  • Stroke* / diagnostic imaging
  • Thrombosis* / complications
  • Thrombosis* / diagnostic imaging