A super instructive case by Alex Solich MD, Ph.D. Neurointerventional Program, Örebro University, Sweden
Lest anyone think carotid webs are a minor nuisance with an occasional small embolus, unimportant in the big scheme of stroke risk factors — no, no, no, no!
Young patient with left MCA syndrome
Aspiration 8 min groin to TICI 3 — organized white thrombus
A bit of hemorrhage in the inferior parietal sulcus. TEE – medium PFO. Several 40-60 sec runs of afib on telemetry
However, 2.5 days later…
Another TICI 3 — organized white thrombus
After 33 hours — guess what?
TICI 2C — the good distal angular kind. Thrombus well organized, required triever + aspiration
All hypercoagulable workup is negative
Next day — 4th time…
TICI 3 of another T
The culprit is a Carotid Web — see how terrible they can be — and an important cause of emboli and stroke — including recurrent big ones — in the young and healthy.
Angio — the more contrast stasis behind the web, the worse they are
Antiplatelets don’t work well for the big ones — the problem is stasis — so its either anticoagulation or carotid artery stent / endarterectomy
See Carotid Web page as well — but this is the best case to show how important they are