Introduction

Described for 60 years under various names, the carotid web is a suspected cause of cryptogenic stroke, especially in young patients. The web creates an intraluminal protrusion that may contribute to turbulent flow and thrombus embolization into cerebral arteries. Although the carotid web has frequently been related to arterial fibrodysplasia, its natural history and pathological description remain unclear.

Patients

Among all consecutive patients admitted to the stroke unit of Sainte-Anne Hospital and referred to the vascular surgery department from January 2015 to December 2022, we retrospectively identified 9 patients with a carotid web. The surgical specimens of the 9 patients were submitted to systematic pathological analysis.

Results

The patients with a histologically confirmed carotid web were young (median age was 42 years), prominently women (7/9), and presenting with low cardiovascular risk. Eight patients had a stroke proven by a magnetic resonance imaging, and 1 had transient monocular amaurosis. The typical pathological lesion supporting the imaging pattern of the carotid web was a focal eccentric intimal hyperplasia forming a protruding lesion characterized by a population of vascular smooth muscle cells intermingled in an abundant, most often loose extracellular matrix. Pathologically proven thrombus was observed in 4 cases. Importantly atherosclerosis was absent.

Conclusion

Histological features in our 9 cases strengthen carotid web characterization as a homogeneous pattern of localized intimal hyperplasia. It is a unique entity consistent with intimal fibroplasia, distinct from medial fibromuscular dysplasia and early atherosclerosis.

中文翻译：

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颈动脉网是动脉壁发育不良吗？组织学系列

介绍

60 年来，颈动脉网被以各种不同的名称描述，它被怀疑是隐源性中风的病因，尤其是在年轻患者中。该网形成腔内突出物，可能导致紊流和血栓栓塞进入脑动脉。尽管颈动脉网经常与动脉纤维发育不良相关，但其自然史和病理描述仍不清楚。

患者

在2015年1月至2022年12月期间连续入住Sainte-Anne医院卒中病房并转诊至血管外科的所有患者中，我们回顾性地发现了9名颈动脉网患者。对9例患者的手术标本进行系统病理分析。

结果

经组织学证实有颈动脉网的患者很年轻（中位年龄为 42 岁），其中女性居多（7/9），且心血管风险较低。经磁共振成像证实，8 名患者患有中风，1 名患者患有短暂性单眼黑蒙。支持颈动脉网成像模式的典型病理病变是局灶性偏心内膜增生，形成突出病变，其特征是血管平滑肌细胞群混合在丰富的、最常见的是松散的细胞外基质中。病理证实有血栓4例。重要的是不存在动脉粥样硬化。

结论

我们的 9 例病例的组织学特征强化了颈动脉网的特征，即局部内膜增生的均匀模式。它是与内膜纤维增生一致的独特实体，与内侧纤维肌性发育不良和早期动脉粥样硬化不同。