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Abstract Details

Escaping the web: Antiplatelet insufficient for stroke prevention in Carotid Artery Web
Neuro Trauma, Critical Care, and Sports Neurology
P15 - Poster Session 15 (12:00 PM-1:00 PM)
13-014
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CaW is an uncommon cause of ischemic stroke, perhaps underdiagnosed because it requires a high degree of suspicion and awareness to identify, and high quality imaging (CTA, MRA, or conventional cerebral angiogram) to visualize. Incidence is reported at 3.8 (4.3 in women and 3.2 in men) per 100,000 persons in the United States.  A few studies have shown a strong association of CaW with ischemic stroke and recurrent transient ischemic attacks, when compared to age- and sex-matched controls. Treatment of CaW for stroke prevention have included antiplatelets, anticoagulants, stenting and surgery. Optimal treatment is unclear, however surgery may be preferred over antiplatelet therapy due to presumed curative efficacy. We report 3 cases of CaW successfully treated surgery and stenting at our institution after failure of antiplatelet therapy. 
Case series
We report 3 cases of CaW identified by CTA and MRA when shelf-like protrusion on the posterior wall of the ICA bulb were visualized. They were confirmed with conventional cerebral angiogram showing a linear membrane affixed perpendicularly from the ICA wall projecting into the lumen, extending from the posterior aspect of the bulb, just above the common carotid artery bifurcation.  No significant atherosclerotic plaque was noted.  Two patients had otherwise cryptogenic/embolic strokes of undetermined source (ESUS) while one had recurrent TIA. Two were already on antiplatelet therapy upon presentation. Age range was 39-47 years, with normal EKG/telemetry, echocardiogram, autoimmune and hypercoagulable labs. Two received carotid endarterectomy (CEA) and one carotid artery stenting (CAS). None experienced symptoms at outpatient follow up.

CaW should be considered in young patients with recurrent cryptogenic/ESUS appearing strokes and no obvious other etiology. The linear membrane emanating from the posterior aspect of the proximal bulb of the internal carotid artery can be successfully treated with CAS or CEA, especially if the patient failed antiplatelet therapy already. 
Authors/Disclosures
Charles D. Schutt, MD (USF Neurology)
PRESENTER 		Dr. Schutt has nothing to disclose.
Swetha Renati, MD (University of South Florida) Dr. Renati has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Dr. Renati has received personal compensation in the range of $500-$4,999 for serving as a NeuroSAE with Â鶹´«Ã½Ó³»­ .
Jorge J. Pesquera, MD No disclosure on file
Daniel J. Kaplan, DO (University of South Florida) No disclosure on file
Maxim Mokin, MD, PhD (University of South Florida) Dr. Mokin has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. Dr. Mokin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Mokin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Microvention. Dr. Mokin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovus. Dr. Mokin has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Foley Mansfield.
David Z. Rose, MD (USF) Dr. Rose has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Boston Scientific. Dr. Rose has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Chiesi USA. Dr. Rose has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medtronic. Dr. Rose has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Boehringer Ingelheim . Dr. Rose has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for CSL-Behring .