Carotid Webs on CT Angiography

Congress:

ECR 2020

Poster Number:

C-05569

Type:

Educational Exhibit

Keywords:

Not applicable, Embolism / Thrombosis, Education and training, Artifacts, Diagnostic procedure, CT-Angiography, Vascular

Authors:

A. H. Sarrami¹, K. Compagne², A. van der Lugt², A. van Es²; ¹Semnan/IR, ²Rotterdam/NL

DOI:

10.26044/ecr2020/C-05569

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-05569

Fig. 1: Carotid Webs on CT Angiography

Fig. 3: Carotid Web. Oblique sagital view shows a sharp intimal projection arising from...

Fig. 4: Focal intimal thickening. Oblique sagital view shows a small intimal protrusion...

Fig. 5: Sharp atherosclerotic plaque. Oblique sagital view shows a sharp intimal...

Table 1: Probable causes of missing a Carotid Web in CT Angiography

Learning objectives

●To understand the imaging characteristics of Carotid Webs (CW) on CT Angiography (CTA). ●To become familiar with the differential diagnoses of CW and the conditions in which a CW can be missed on CTA.

Background

The Carotid Web (CW) refers to a sharp intimal projection that arises from the posterior wall of a carotid bulb. [1,2] It has been first described by Momose and New about fifty years ago; [3]However, its role as a risk factor of ischemic stroke was unknown until recent years. [4] More recent studies have improved our insight about the epidemiological, clinical and histopathological features of CW [5-9] as well as its management. [10] Approximately 1% of patients who underwent CT angiography (CTA) for suspected acute...

Findings and procedure details

We can evaluate CW with a multiplanar reconstruction view and standard technical parameters. CTA has a comparable diagnostic accuracy with DSA for detecting CW, while it is more available and less invasive. Moreover, CTA is more reliable than carotid Doppler ultrasound and is more applicable than MR angiography in the setting of acute stroke. [7,11] Oblique Sagittal View (OSV): This is the key view in CTA for the detection of CW. [9] There is no further need to coronal nor axial view for the detection...

Conclusion

CTA is a non-invasive imaging modality allowing the accurate detection of a CW and the evaluation possible differential diagnoses. Proper understanding of the imaging characteristics CW increases the chance of detecting a CW. This enables management of a CW in a timely manner, and eventually decreases the risk of ischemic stroke recurrence.

Personal information and conflict of interest

A. H. Sarrami; Semnan/IR - nothing to disclose K. Compagne; Rotterdam/NL - nothing to disclose A. van der Lugt; Rotterdam/NL - nothing to disclose A. van Es; Rotterdam/NL - nothing to disclose

References

1- Kim SJ, Nogueira RG, Haussen DC. Current Understanding and Gaps in Research of Carotid Webs in Ischemic Strokes: A Review. JAMA Neurol.2019;76(3):355-361. 2- Zhang AJ, Dhruv P, Choi P, Bakker C, Koffel J, Anderson D, Kim J, Jagadeesan B, Menon BK, Streib C. A Systematic Literature Review of Patients With Carotid Web and Acute Ischemic Stroke. Stroke. 2018 Dec;49(12):2872-2876. 3- Momose KJ, New PF. Non-atheromatous stenosis and occlusion of the internal carotid artery and its main branches. Am J Roentgenol Radium Ther Nucl Med....