Carotid web leads to new thrombus formation: computational fluid dynamic analysis coupled with histological evidence
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CASE REPORT - VASCULAR NEUROSURGERY - ISCHEMIA
Carotid web leads to new thrombus formation: computational fluid dynamic analysis coupled with histological evidence Dan Ozaki 1 & Toshiki Endo 1 & Hiroyoshi Suzuki 2 & Shin-ichiro Sugiyama 3 & Kaoru Endo 4 & Ryo Itabashi 4 & Miki Fujimura 1 & Teiji Tominaga 5 Received: 20 November 2019 / Accepted: 19 February 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
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. Keywords Carotid web . Recurrent stroke . Carotid endarterectomy . Computational fluid dynamics
Abbreviations CAS Carotid artery stenting CEA Carotid endarterectomy CFD Computational fluid dynamics FMD Fibromuscular dysplasia
This article is part of the Topical Collection on Vascular Neurosurgery Ischemia. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04272-2) contains supplementary material, which is available to authorized users. * Toshiki Endo [email protected] 1
Department of neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami Taihaku, Sendai 982-8523, Japan
2
Departments of Pathology and Laboratory Medicine, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan
3
Department of Neuroanesthesia, Kohnan Hospital, Sendai, Miyagi, Japan
4
Department of Stroke Neurology, Kohnan Hospital, Sendai, Miyagi, Japan
5
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
Introduction Carotid web is the angiographical description of a linear spurlike intraluminal projection along the posterior wall of the proximal internal carotid artery (ICA) [3, 18]. The histological hallmark of a carotid web is fibrous intimal thickening [10, 27]. This is different from typical atherosclerotic disease [7]. Rather, the carotid web is regarded as a variant of fibromuscular dysplasia (FMD) [25, 28]. FMD is an idiopathic, segmental, noninflammatory, and non-atherosclerotic disease classified into three types according to the arterial layer affected: intimal, medial, and adventitial fibroplasia [22]. A carotid web is recognized to be pathologically equivalent to an intimal FMD. Carotid webs can cause ischemic stroke especially in young women [4]. The resulting blood stasis is hypothesized to lead to thrombus formation and later, thromboembolic stroke [26]. The stroke recurrence rate is high under the medical treatment [
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