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Carotid web leads to new thrombus formation: computational fluid dynamic analysis coupled with histological evidence

  • Case Report - Vascular Neurosurgery - Ischemia
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Abstract

Carotid web has been recognized as a rare cause of ischemic stroke with high recurrence rate. We describe a 48-year-old woman with carotid web who developed embolic stroke. We obtained a fresh thrombus from the internal carotid artery when carotid endarterectomy was performed. A preoperative computational fluid dynamics (CFD) study showed stagnation of blood around the web structure as well as the low wall shear stress. The rheological analysis newly disclosed mechanisms of thrombus formation related to the carotid web. CFD study in the carotid web may determine indication and timing of surgical interventions with further accumulation of clinical evidence.

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Abbreviations

CAS:

Carotid artery stenting

CEA:

Carotid endarterectomy

CFD:

Computational fluid dynamics

FMD:

Fibromuscular dysplasia

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Author information

Authors and Affiliations

  1. Department of neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami Taihaku, Sendai, 982-8523, Japan

    Dan Ozaki, Toshiki Endo & Miki Fujimura

  2. Departments of Pathology and Laboratory Medicine, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan

    Hiroyoshi Suzuki

  3. Department of Neuroanesthesia, Kohnan Hospital, Sendai, Miyagi, Japan

    Shin-ichiro Sugiyama

  4. Department of Stroke Neurology, Kohnan Hospital, Sendai, Miyagi, Japan

    Kaoru Endo & Ryo Itabashi

  5. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

    Teiji Tominaga

Authors
  1. Dan Ozaki
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  2. Toshiki Endo
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  3. Hiroyoshi Suzuki
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  4. Shin-ichiro Sugiyama
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  5. Kaoru Endo
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Contributions

Conception and design: Endo T, Itabashi R, Fujimura M, Tominaga T. Acquisition of data: all authors. Analysis and interpretation of data: Endo T, Suzuki H, Sugiyama S, Fujimura M. Drafting the article: Ozaki D, Endo T, Sugiyama S, Endo K. Critically revising the article: Suzuki H, Itabashi R, Fujimura M, Tominaga T. Reviewed final version of the manuscript and approved it for submission: All authors.

Corresponding author

Correspondence to Toshiki Endo.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. For this type of study, formal consent is not required.

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Comments

The authors reported an interesting case of symptomatic carotid web successfully treated by carotid endarterectomy (CEA). Carotid web is rare but well-known cause of ischemic stroke especially in relatively young female patients’ group. In the acute phase of initial embolic stroke, they nicely treated the patient using endovascular thrombectomy following intra-venous t-PA infusion. Their computational fluid dynamics (CFD) study revealed stagnation of blood around the web structure as well as the low wall shear stress. Then they performed CEA, and thrombus formation was observed at the carotid web by the histological examination. The significance of this manuscript was their logical surgical strategy using preoperative CFD analysis.

Kenji Sugiu

Okayama, Japan

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This article is part of the Topical Collection on Vascular Neurosurgery - Ischemia.

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ESM 1

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ESM 2

Video. During the surgery, a soft fresh thrombus was removed soon after the arteriotomy. There was a shelf-like structure on the posterior wall of the ICA. We dissected between the intimal and medial layers of the arterial wall and resected it together with the web (video). (MPG 138060 kb)

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Ozaki, D., Endo, T., Suzuki, H. et al. Carotid web leads to new thrombus formation: computational fluid dynamic analysis coupled with histological evidence. Acta Neurochir 162, 2583–2588 (2020). https://doi.org/10.1007/s00701-020-04272-2

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  • DOI: https://doi.org/10.1007/s00701-020-04272-2

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